Provider Demographics
NPI:1154878098
Name:MOTON, LORI (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MOTON
Suffix:
Gender:
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4703
Mailing Address - Country:US
Mailing Address - Phone:217-333-2700
Mailing Address - Fax:
Practice Address - Street 1:1109 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4703
Practice Address - Country:US
Practice Address - Phone:217-333-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041341511163WH0200X
IL277003668363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health