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Lisle Blackbourn
Student in an Organized Health Care Education/Training Program in Peoria, Illinois
NPI 1043960156

Lisle Blackbourn is a Student in an Organized Health Care Education/Training Program based in Elkhorn, IL. Lisle Blackbourn practices in Peoria, IL. The NPI Number for Lisle Blackbourn is 1043960156 and holds a License No. (Illinois).

The current practice location address for Lisle Blackbourn is 530 Ne Glen Oak Ave, Peoria, IL and can be reached out via phone at 309-655-2000.

Location: 530 Ne Glen Oak Ave, Peoria, IL, 53121-4063
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1043960156
Provider Name
Lisle Blackbourn
Credential
Provider Entity Type
Individual
Gender
Male
Address
530 Ne Glen Oak Ave, Peoria, IL, 53121-4063
Phone Number
309-655-2000
Fax Number
Provider Enumeration Date
03/24/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2000
Fax Number
person
Provider Business Mailing Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2000
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
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.
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