Healthcare Provider Details

I. General information

NPI: 1023765856
Provider Name (Legal Business Name): LILLIAN ANNE LYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MCHENRY RD
WHEELING IL
60090-2696
US

IV. Provider business mailing address

507 N 17TH ST
MILWAUKEE WI
53233-2104
US

V. Phone/Fax

Practice location:
  • Phone: 847-243-9252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009089
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: