Provider Demographics
NPI:1134421506
Name:LENTINI, ANNA MARIA (APN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:LENTINI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:DICARLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-588-2600
Mailing Address - Fax:
Practice Address - Street 1:3132 OLD JACKSONVILLE RD STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7401
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008447OtherLICENSE NUMBER
IL209008447OtherLICENSE NUMBER
IL$$$$$$$$$001Medicaid