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General NPI Number Information
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NPI Number | 1013661859
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Entity Type | Individual
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Provider Name | CHIBUZO LASISI
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 305 N VINE ST UNIT 100A
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City | NEW LENOX
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State | IL
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Zip | 60451-1652
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Country | US
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Telephone | 815-435-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 4749 LINCOLN MALL DR STE 202H
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City | MATTESON
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State | IL
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Zip | 60443-3826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277004019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277004019
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License Number State | IL
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