Individual
LORI A. DEFREESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8750
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8750
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.014513
IL
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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