Provider Demographics
NPI:1962175562
Name:LEMUS, MARCELA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:RENEE
Last Name:LEMUS
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 1:1811 STROBLE AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1271
Mailing Address - Country:US
Mailing Address - Phone:407-452-9570
Mailing Address - Fax:
Practice Address - Street 1:1811 STROBLE AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1271
Practice Address - Country:US
Practice Address - Phone:407-452-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily