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General NPI Number Information
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NPI Number | 1619787678
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Entity Type | Organization
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Legal Business Name | WOUNDCENTRIX, PLLC
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 11013 N WOODSTOCK ST UNIT 94
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City | HUNTLEY
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State | IL
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Zip | 60142-4404
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Country | US
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Telephone | 815-781-2680
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Fax | 815-604-8044
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 815-781-2608
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Fax | 815-604-8044
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Authorized Official
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Title or Position | CEO
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Name | LISA MARIE LORING
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Credential | FNP, C
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Telephone | 815-781-2608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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