Lisle Blackbourn

NPI #1043960156 in Peoria, Illinois

Provider Information

NPI Number: 1043960156
Entity Type: Individual
Name: Lisle Blackbourn
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Mar 24, 2022
Last Updated: Mar 24, 2022

Practice Location

Address: 530 NE GLEN OAK AVE
City: Peoria
State: Illinois
ZIP Code: 61637-0001
Phone: (309) 655-2000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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