Provider Demographics
NPI:1699740308
Name:IOCCA, LORRAINE LEE (RN,MS,BC-ADM,CDE)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:LEE
Last Name:IOCCA
Suffix:
Gender:F
Credentials:RN,MS,BC-ADM,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 FARRAGUT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1433
Mailing Address - Country:US
Mailing Address - Phone:217-787-8870
Mailing Address - Fax:217-787-8234
Practice Address - Street 1:2528 FARRAGUT DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1433
Practice Address - Country:US
Practice Address - Phone:217-787-8870
Practice Address - Fax:217-787-8234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205928Medicare PIN