Healthcare Provider Details

I. General information

NPI: 1881994432
Provider Name (Legal Business Name): AMBER L LENSTROM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 N LINCOLN AVE SUITE 27
CHICAGO IL
60659-4714
US

IV. Provider business mailing address

5757 N LINCOLN AVE SUITE 27
CHICAGO IL
60659-4714
US

V. Phone/Fax

Practice location:
  • Phone: 773-728-5133
  • Fax: 773-728-5134
Mailing address:
  • Phone: 773-728-5133
  • Fax: 773-728-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.003819
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number124234
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8496-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: