Individual
MS. LORI LANDRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1275 HAWTHORN RD, SALEM, IL 62881-1028
(618) 548-4590
(618) 548-8275
Mailing address
1275 HAWTHORN RD, SALEM, IL 62881-1028
(618) 548-4590
(618) 548-8275
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209.011381
IL
363LP0200X
Pediatric Nurse Practitioner
ARNP9382830
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HU297Z
MEDICARE PTAN
FL
Enumeration date
05/17/2014
Last updated
05/17/2021
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