Healthcare Provider Details

I. General information

NPI: 1821695487
Provider Name (Legal Business Name): ADA YANCI LEMUS I FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADA YANCI LEMUS FNP, PMHNP

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6447 CERMAK RD
BERWYN IL
60402-2311
US

IV. Provider business mailing address

4931 W AINSLIE ST
CHICAGO IL
60630-2449
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax: 708-484-5413
Mailing address:
  • Phone: 312-523-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021679
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277003565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: