Provider Demographics
NPI:1790795474
Name:VERHEY, LORRITA MARIE (APN,FNP)
Entity Type:Individual
Prefix:
First Name:LORRITA
Middle Name:MARIE
Last Name:VERHEY
Suffix:
Gender:F
Credentials:APN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S. DAMEN AVE.
Mailing Address - Street 2:SUITE 938
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7350
Mailing Address - Country:US
Mailing Address - Phone:312-996-8009
Mailing Address - Fax:312-996-7725
Practice Address - Street 1:734 W. 47TH STREET SOUTH
Practice Address - Street 2:IHC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609
Practice Address - Country:US
Practice Address - Phone:773-536-8400
Practice Address - Fax:773-536-2406
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0040030716OtherBC/BS
IL0040030716OtherBC/BS
ILS80963Medicare UPIN