Healthcare Provider Details

I. General information

NPI: 1295947331
Provider Name (Legal Business Name): LISA MARIE WILLIAMS RN, MS, AACRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST GALTER PAVILION, SUITE 13-205
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

1509 MAPLE AVE
DOWNERS GROVE IL
60515-4526
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-4114
  • Fax: 312-926-9630
Mailing address:
  • Phone: 630-963-7958
  • Fax: 312-926-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: