Organization
LORIE ROSE WENDT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ELMER CPCS (CREDENTIALING)
(608) 352-8323
Entity
Organization
Contact information
Practice address
2323 SANDHUTTON AVE, ROCKFORD, IL 61108-8087
(815) 566-2052
Mailing address
2323 SANDHUTTON AVE, ROCKFORD, IL 61108-8087
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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