Individual
CAROL J LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3132 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704
(217) 588-2600
(217) 862-0904
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 588-2624
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209017355
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041361033
RN LICNESE
IL
Enumeration date
01/19/2018
Last updated
08/10/2018
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