Basic Information
| Provider Information | |||||||||
| NPI: | 1841541745 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CVS MINUTE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2948 N SEMINARY AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606577085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303342565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11200 LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | MOKENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604488208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154642171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | LYNDSEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6303342565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | IL | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.