Provider Demographics
NPI:1194723312
Name:LOAR, RICKI (APN)
Entity type:Individual
Prefix:MRS
First Name:RICKI
Middle Name:
Last Name:LOAR
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 W PETERSON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3200
Mailing Address - Country:US
Mailing Address - Phone:773-267-3807
Mailing Address - Fax:
Practice Address - Street 1:670 PIERCE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2579
Practice Address - Country:US
Practice Address - Phone:618-206-2094
Practice Address - Fax:618-607-5127
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0086728363LF0000X, 363LG0600X
IL209001078363LG0600X
IL209-001078363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194723312Medicare UPIN