Provider Demographics
NPI:1700215928
Name:NOTTMEYER, LORI A (APN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:NOTTMEYER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:HUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:200 RICHMOND AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4652
Practice Address - Country:US
Practice Address - Phone:217-234-7000
Practice Address - Fax:217-234-7011
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily