Provider Demographics
NPI:1255438313
Name:NELSON, LORI JANE (APRN, BC, CNS)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JANE
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN, BC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 N ORCHARD ST
Mailing Address - Street 2:TOWNHOUSE C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2070
Mailing Address - Country:US
Mailing Address - Phone:312-550-1238
Mailing Address - Fax:773-792-5179
Practice Address - Street 1:7435 W TALCOTT AVE
Practice Address - Street 2:PIR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3707
Practice Address - Country:US
Practice Address - Phone:773-774-8000
Practice Address - Fax:773-792-5179
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005561364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19576Medicare ID - Type UnspecifiedMEMBER NUMBER
IL809340Medicare UPIN