Provider Demographics
NPI:1770140493
Name:LAMPIGNANO, IDA ROSA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:ROSA
Last Name:LAMPIGNANO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9272
Mailing Address - Country:US
Mailing Address - Phone:630-675-8947
Mailing Address - Fax:
Practice Address - Street 1:882 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-9272
Practice Address - Country:US
Practice Address - Phone:630-675-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL209019657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program