Healthcare Provider Details

I. General information

NPI: 1801329743
Provider Name (Legal Business Name): LISAMARIE MURDOCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISAMARIE SCHREIBER

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 165TH ST
ORLAND PARK IL
60467-8713
US

IV. Provider business mailing address

10745 165TH ST
ORLAND PARK IL
60467-8713
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-8384
  • Fax:
Mailing address:
  • Phone: 708-799-8384
  • Fax: 708-799-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209015607
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: