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NPI Code Detail

MEDICARE: LORY JOANNA ARQUILLA-MALTBY NP

MEDICARE: LORY JOANNA ARQUILLA-MALTBY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner209-004916IL

General Provider Information

NPI Number : 1205866373
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORY JOANNA ARQUILLA-MALTBY NP
Provider Business Mailing Address
First Line : 921 DUNLOP AVE
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-2242
Country : US
Telephone Number : 708-771-8425
Fax Number :
Provider Business Practice Location Address
First Line : 7733 W GRAND AVE
Second Line :
City : ELMWOOD PARK
State : IL
Zip : 60707-1820
Country : US
Telephone Number : 708-452-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 03/13/2010

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