Provider Demographics
NPI:1033650940
Name:SIBY, LISA K
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:SIBY
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 1:1355 REMINGTON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4832
Mailing Address - Country:US
Mailing Address - Phone:630-701-9009
Mailing Address - Fax:
Practice Address - Street 1:1355 REMINGTON RD
Practice Address - Street 2:SUITE H
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4832
Practice Address - Country:US
Practice Address - Phone:630-701-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner