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NPI Code Detail

MEDICARE: LISA PRICE APN

MEDICARE: LISA PRICE APN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209014021IL
2363L00000XNurse Practitioner209014021IL

General Provider Information

NPI Number : 1760843379
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA PRICE APN
Provider Business Mailing Address
First Line : PO BOX 372
Second Line :
City : MATTOON
State : IL
Zip : 61938-0372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2040 LINCOLN AVE STE 100
Second Line :
City : CHARLESTON
State : IL
Zip : 61920-3197
Country : US
Telephone Number : 217-345-2030
Fax Number : 217-345-2045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2016
Last Update Date : 11/05/2024

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Directions to “ LISA PRICE APN” Practice Location

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