LISA NANNIE FNP NPI 1417962937

NPI Information

  • NPI: 1417962937
  • Provider Name: LISA NANNIE, FNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 8914 N KNOXVILLE AVE
    PEORIA, IL
    ZIP 61615
  • Phone: (309) 691-9110

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NPI Details

Lisa Nannie, FNP is a family nurse practitioner in Peoria, IL. Lisa Nannie, FNP NPI is 1417962937. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

8914 N KNOXVILLE AVE
PEORIA, IL
ZIP 61615-410
Phone: (309) 691-9110

The NPI 1417962937 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2006 and was last updated on 10/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily209001338ILLINOISYes
2363LP2300XNurse PractitionerPrimary Care209001338ILLINOISNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1050884OTHERILLINOISHEALTH ALLIANCE
2IL01W1OTHERILLINOISJOHN DEERE
3472307OTHERILLINOISHEALTHLINK
47215059OTHERILLINOISBCBS PPO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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