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General NPI Number Information
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NPI Number | 1891463220
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Entity Type | Individual
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Provider Name | ANNE MARIE LODEWYCK FNP, NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 754 S 8TH ST
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City | WEST DUNDEE
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State | IL
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Zip | 60118-2102
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Country | US
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Telephone | 847-836-5202
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Fax | 847-836-5209
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Provider Business Mailing Address
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Address Line | 754 S 8TH ST
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City | WEST DUNDEE
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State | IL
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Zip | 60118-2102
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Country | US
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Telephone | 847-836-5202
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Fax | 630-300-3702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 209.023864
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License Number State | IL
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