Healthcare Provider Details

I. General information

NPI: 1346021094
Provider Name (Legal Business Name): LISA ANNERINO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12341 HERITAGE MEADOWS DR
PLAINFIELD IL
60585-6176
US

IV. Provider business mailing address

12341 HERITAGE MEADOWS DR
PLAINFIELD IL
60585-6176
US

V. Phone/Fax

Practice location:
  • Phone: 630-542-2806
  • Fax:
Mailing address:
  • Phone: 630-542-2806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020.012196
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: