Provider Demographics
NPI:1639518657
Name:LAMONTE, COLLEEN ANNE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANNE
Last Name:LAMONTE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 READ ST STE D
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3265
Mailing Address - Country:US
Mailing Address - Phone:815-838-7337
Mailing Address - Fax:815-838-5007
Practice Address - Street 1:300 READ ST STE D
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3265
Practice Address - Country:US
Practice Address - Phone:815-838-7337
Practice Address - Fax:815-838-5007
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010472363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics