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General NPI Number Information
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NPI Number | 1578918561
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Entity Type | Individual
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Provider Name | LISA TINDALL
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 3330 SKOKIE VALLEY RD STE 200
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1041
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Country | US
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Telephone | 847-386-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 LYBARGER LN
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City | ELLIS GROVE
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State | IL
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Zip | 62241-1843
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Country | US
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Telephone | 618-534-7890
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2018007549
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209014141
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License Number State | IL
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