Healthcare Provider Details

I. General information

NPI: 1912424110
Provider Name (Legal Business Name): LISA MARIE DROST ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W FOREST AVE
WHEATON IL
60187-3557
US

IV. Provider business mailing address

315 W FOREST AVE
WHEATON IL
60187-3557
US

V. Phone/Fax

Practice location:
  • Phone: 630-920-3485
  • Fax:
Mailing address:
  • Phone: 630-920-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164.006932
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0000153
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: