MEDICARE: LISA OREILLY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	277005262	IL

General Provider Information

NPI Number	:	1699238220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA OREILLY RN

Provider Business Mailing Address
First Line	:	3258 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2729
Country	:	US
Telephone Number	:	773-629-8217
Fax Number	:

Provider Business Practice Location Address
First Line	:	3258 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655
Country	:	US
Telephone Number	:	773-629-8217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	03/09/2026

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