Nannie, Lisa

Nannie, Lisa is an individual health care provider with primary practice located at 8914 N Knoxville Ave , Peoria IL 61615-1410. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Nannie, Lisa can be contacted via phone (309) 691-9110.

Contact Information

Primary practice address
8914 N Knoxville Ave Peoria IL 61615-1410
Phone: (309) 691-9110
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209001338 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 209001338 Illinois

Profile Details

NPI number 1417962937
LBN Legal business name Nannie, Lisa
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Oct 12th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1417962937 NPPES
Illinois Other 050884 HEALTH ALLIANCE
Illinois Other IL01W1 HEALTH ALLIANCE
Illinois Other 472307 HEALTH ALLIANCE
Illinois Other 7215059 HEALTH ALLIANCE

Popular Providers