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General NPI Number Information
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NPI Number | 1598010902
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Entity Type | Individual
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Provider Name | LISA ANN LANDERS RN, ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 1740 W. TAYLOR STREET SUITE 2488
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-413-2698
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Fax |
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Provider Business Mailing Address
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Address Line | 1265 W FLOURNOY ST APT B
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City | CHICAGO
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State | IL
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Zip | 60607-3324
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 277.002334
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License Number State | IL
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