Provider Demographics
NPI:1356317127
Name:LANK, NANCY (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:LANK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2953
Mailing Address - Country:US
Mailing Address - Phone:309-787-2600
Mailing Address - Fax:309-787-2643
Practice Address - Street 1:1929 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2953
Practice Address - Country:US
Practice Address - Phone:309-787-2600
Practice Address - Fax:309-787-2643
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086233207Q00000X
IA01532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
362739299032OtherTRICARE E MOLINE
91435OtherBCWELLMARK MOLINE
143413OtherIHS
IA3017491Medicaid
IL01Q7OtherJOHN DEERE MOLINE
036086233OtherBCILLINOIS
362739299031OtherTRICARE MOLINE
IA4017491Medicaid
IL01Q8OtherJOHN DEERE E MOLINE
97631OtherBCWELLMARK E MOLINE
IA4017491Medicaid
L95940Medicare ID - Type UnspecifiedINDIVIDUAL
IA3017491Medicaid