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General NPI Number Information
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NPI Number | 1528875564
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Entity Type | Organization
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Legal Business Name | MINUTECLINIC PRIMARY CARE ILLINOIS PLLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 11200 LINCOLN HWY
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City | MOKENA
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State | IL
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Zip | 60448-8208
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 772
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City | WOONSOCKET
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State | RI
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Zip | 02895-0784
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DEBORAH PINCINCE
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Credential |
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Telephone | 400-177-0381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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