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Individual

TERESA A LANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 624-4000
(309) 624-4010
Mailing address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 624-4000
(309) 624-4010

Taxonomy

Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
209008755
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
370662569
IL
Enumeration date
04/07/2011
Last updated
03/25/2016
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