Provider Demographics
NPI:1487959300
Name:O'GRADY, LORI M (NP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:M
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 N WHEATON AVE UNIT 1072
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6492
Mailing Address - Country:US
Mailing Address - Phone:630-344-9756
Mailing Address - Fax:630-348-7421
Practice Address - Street 1:122 N WHEATON AVE UNIT 1072
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6492
Practice Address - Country:US
Practice Address - Phone:630-344-9756
Practice Address - Fax:630-348-7421
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001311363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
234682Medicare UPIN