MEDICARE: LISA M RODRIGUEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	209.034500	IL

General Provider Information

NPI Number	:	1588503312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M RODRIGUEZ APRN

Provider Business Mailing Address
First Line	:	5280 BEECHWOOD AVE
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-1787
Country	:	US
Telephone Number	:	847-912-8101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1272 AMERICAN WAY
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3936
Country	:	US
Telephone Number	:	847-549-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	06/10/2026

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