Provider Demographics
NPI:1063289478
Name:SMALLHORN, LUCILLE ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ELIZABETH
Last Name:SMALLHORN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 BELLEPARK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-4172
Mailing Address - Country:US
Mailing Address - Phone:217-962-1892
Mailing Address - Fax:
Practice Address - Street 1:516 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5657
Practice Address - Country:US
Practice Address - Phone:217-962-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028680207Q00000X
IL209028680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine