Provider Demographics
NPI:1336561646
Name:LOEHNER, LINDSAY M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:LOEHNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CONGRESS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6235
Mailing Address - Country:US
Mailing Address - Phone:815-477-0300
Mailing Address - Fax:815-477-0301
Practice Address - Street 1:260 E CONGRESS PKWY STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-477-0300
Practice Address - Fax:815-477-0301
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010553363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041365976OtherSTATE LICENSE
IL209010553OtherSTATE LICENSE