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Organization
MEMORIAL PHYSICIAN SERVICES
Active
Organization
MEMORIAL PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORALEE DONNELLY FNP (FAMILY NURSE PRACTITIONER)
(217) 741-5055
Entity
Organization
Contact information
Practice address
3132 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7400
(217) 862-0800
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
209.014926
IL
363LF0000X
Family Nurse Practitioner
Primary
209.014926
IL
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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