Provider Demographics
NPI:1033983861
Name:REID, LISA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:REID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5364 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SHIPMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62685-6005
Mailing Address - Country:US
Mailing Address - Phone:217-419-1150
Mailing Address - Fax:
Practice Address - Street 1:5364 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SHIPMAN
Practice Address - State:IL
Practice Address - Zip Code:62685-6005
Practice Address - Country:US
Practice Address - Phone:217-419-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily