| Doctor Name: | LEE A TARDINO |
| NPI Number: | 1023120797 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN ANP |
| License Number: | 148611 |
| Business Practice Address: | 815 E 5th St Suite 202 Alton, IL - 620026471 |
| Business Phone Number: | 6184624939 |
| Business Fax Number: | 6184625956 |
| Mailing Address: | 815 E 5th St, Suite 202 ALTON |
| State: | IL |
| Postal Code: | 620026471 |
| Phone Number: | 6184624939 |
| Fax Number: | 6184625956 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 11/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 148611 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |