Provider Demographics
NPI:1013396381
Name:ZAYAN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3194 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2409
Mailing Address - Country:US
Mailing Address - Phone:847-537-5555
Mailing Address - Fax:877-432-7816
Practice Address - Street 1:3357 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1908
Practice Address - Country:US
Practice Address - Phone:847-537-5555
Practice Address - Fax:877-432-7816
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041206716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse