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General NPI Number Information
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NPI Number | 1982818084
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Entity Type | Individual
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Provider Name | LISA REICHARDT MS, APRN, CWOCN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 15915 S CRYSTAL CREEK DR STE 8
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City | HOMER GLEN
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State | IL
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Zip | 60491-9284
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Country | US
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Telephone | 708-400-8063
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Fax |
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Provider Business Mailing Address
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Address Line | 325 S PARK RD
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City | LA GRANGE
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State | IL
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Zip | 60525-2128
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Country | US
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Telephone | 708-579-3191
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 209-005646
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 277.000713
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License Number State | IL
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