NPI 1356485809 · live from the CMS NPI Registry
Minuteclinic Diagnostic Of Illinois PLLC
Nurse Practitioner, Family in Mokena, IL. National Provider Identifier 1356485809, active.
NPI record
| NPI | 1356485809 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 11200 W Lincoln Hwy, Mokena, IL 60448 |
| Practice phone | 866-389-2727 |
| Mailing address | 1 Cvs Dr, Minuteclinic Mc-2295, Woonsocket, RI 02895 |
| Enumerated | February 17, 2007 |
| Last updated | July 24, 2024 |
| Authorized official | Deborah Pincince, Administrator |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Professional | 101YP2500X | — |
| Social Worker, Clinical | 1041C0700X | — |
| Marriage & Family Therapist | 106H00000X | — |
| Nurse Practitioner, Family primary | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.