Individual
LISA MOMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 CURTIS RD, CHAMPAIGN, IL 61822-9678
(217) 365-6201
(217) 326-4003
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2500
(217) 383-6941
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.011117
IL
Other
Enumeration date
02/18/2014
Last updated
02/28/2014
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