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General NPI Number Information
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NPI Number | 1619586518
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Entity Type | Individual
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Provider Name | LISA K ANDERSON-SHAW APN, BC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | MACNEAL TRINITY MEDICAL CETNER 3249 OAK PARK AVENUE
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-738-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E WATERSIDE DR UNIT 3910
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City | CHICAGO
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State | IL
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Zip | 60601-8026
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Country | US
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Telephone | 312-636-4908
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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 | 174V00000X
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Taxonomy Name | Clinical Ethicist
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License Number | 209001980
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License Number State | IL
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