Individual
LORNA KATHLEEN ILLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
20370 POE SHOLES DR, BEND, OR 97703-7938
(541) 318-1377
Mailing address
20370 POE SHOLES DR, BEND, OR 97703-7938
(541) 318-1377
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201241660RN
OR
163WE0003X
Emergency Registered Nurse
201241660RN
OR
Other
Enumeration date
04/11/2013
Last updated
04/04/2017
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