Healthcare Provider Details

I. General information

NPI: 1932784006
Provider Name (Legal Business Name): LIFESAVER HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 S YATES BLVD SUITE 201
CHICAGO IL
60617
US

IV. Provider business mailing address

7929 S YATES BLVD SUITE 201
CHICAGO IL
60617
US

V. Phone/Fax

Practice location:
  • Phone: 877-799-7412
  • Fax: 773-922-0178
Mailing address:
  • Phone: 773-552-2465
  • Fax: 773-922-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRANDY LYNN HANSON
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 773-552-2465