Provider Demographics
NPI:1427325711
Name:FEARON, LORRAINE MARIE (APN)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:MARIE
Last Name:FEARON
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 1:2160 S. FIRST AVE.
Mailing Address - Street 2:BUILDING 150 ROOM 3201
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-2312
Mailing Address - Fax:708-216-7853
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:BUILDING 150 ROOM 3201
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-2312
Practice Address - Fax:708-216-7853
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.000726163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMF 1924718OtherDEA