=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841541745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CVS MINUTE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 10/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11200 LINCOLN HWY
-----------------------------------------------------
City | MOKENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60448-8208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-464-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2948 N SEMINARY AVE APT 3
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-7085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-334-2565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. LYNDSEY POWELL
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 630-334-2565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------