Lisle Blackbourn is a student in an organized health care education training program in Peoria, IL. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Lisle Blackbourn NPI is 1043960156. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637-001
Phone: (309) 655-2000
The enumeration date for this NPI number is 3/24/2022 and was last updated on 3/24/2022.