Provider Demographics
NPI:1568793453
Name:VANHORN, LORI (DNP MSN, RN, APNP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:VANHORN
Suffix:
Gender:F
Credentials:DNP MSN, RN, APNP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:FATLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2361 PAYSPHERE CIRCLE CANCER TREATMENT CENTERS OF AMERI
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:2520 ELISHA AVENUE
Practice Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3875363L00000X
IL209013770363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568793453Medicaid
WI1568793453Medicare NSC