Healthcare Provider Details

I. General information

NPI: 1164707691
Provider Name (Legal Business Name): LISA C BELL RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2011
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 W MAIN ST SUITE 9
MONEE IL
60449-8101
US

IV. Provider business mailing address

5410 W MAIN ST SUITE 9
MONEE IL
60449-8101
US

V. Phone/Fax

Practice location:
  • Phone: 773-444-8591
  • Fax:
Mailing address:
  • Phone: 773-444-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041.382654
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041.382654
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014476
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: