Healthcare Provider Details

I. General information

NPI: 1588503312
Provider Name (Legal Business Name): LISA RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 BEECHWOOD AVE
GURNEE IL
60031-1787
US

IV. Provider business mailing address

5280 BEECHWOOD AVE
GURNEE IL
60031-1787
US

V. Phone/Fax

Practice location:
  • Phone: 847-912-8101
  • Fax:
Mailing address:
  • Phone: 847-912-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.034500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: