Healthcare Provider Details

I. General information

NPI: 1770495780
Provider Name (Legal Business Name): MRS. LISSY G MOLAYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 N HIGHLAND AVE
ELMHURST IL
60126-2538
US

IV. Provider business mailing address

195 N HIGHLAND AVE
ELMHURST IL
60126-2538
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-5104
  • Fax:
Mailing address:
  • Phone: 708-202-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041.309394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: