Provider Demographics
NPI:1649096314
Name:LANOUE, JEFFREY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LANOUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 N 1630 EAST RD
Mailing Address - Street 2:
Mailing Address - City:MARTINTON
Mailing Address - State:IL
Mailing Address - Zip Code:60951-6055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2668 N 1630 EAST RD
Practice Address - Street 2:
Practice Address - City:MARTINTON
Practice Address - State:IL
Practice Address - Zip Code:60951-6055
Practice Address - Country:US
Practice Address - Phone:815-428-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL500390027544251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care