Healthcare Provider Details

I. General information

NPI: 1053729178
Provider Name (Legal Business Name): LISA ADREANI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S EMERSON ST
MT PROSPECT IL
60056-3220
US

IV. Provider business mailing address

4829 CRAIN ST APT 1
SKOKIE IL
60077-5431
US

V. Phone/Fax

Practice location:
  • Phone: 847-368-1234
  • Fax: 847-603-7478
Mailing address:
  • Phone: 847-924-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.011882
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: