Provider Demographics
NPI:1013319623
Name:LORD, NICOLE M (APRN, CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:LORD
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:ULM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1297
Mailing Address - Country:US
Mailing Address - Phone:309-451-2080
Mailing Address - Fax:
Practice Address - Street 1:1730 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1297
Practice Address - Country:US
Practice Address - Phone:309-451-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001436363LF0000X
IL309007641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily