MEDICARE: LORI JANE NELSON APRN, BC, CNS

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	377.00584	IL
2	364S00000X	Clinical Nurse Specialist	209-005561	IL

General Provider Information

NPI Number	:	1255438313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JANE NELSON APRN, BC, CNS

Provider Business Mailing Address
First Line	:	1708 N ORCHARD ST
Second Line	:	TOWNHOUSE C
City	:	CHICAGO
State	:	IL
Zip	:	60614-2070
Country	:	US
Telephone Number	:	312-550-1238
Fax Number	:	773-792-5179

Provider Business Practice Location Address
First Line	:	7435 W TALCOTT AVE
Second Line	:	PIR
City	:	CHICAGO
State	:	IL
Zip	:	60631-3707
Country	:	US
Telephone Number	:	773-774-8000
Fax Number	:	773-792-5179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/04/2026

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