Provider Demographics
NPI:1164707691
Name:BELL, LISA C (RN, FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:BELL
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 W MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8101
Mailing Address - Country:US
Mailing Address - Phone:773-444-8591
Mailing Address - Fax:
Practice Address - Street 1:5410 W MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8101
Practice Address - Country:US
Practice Address - Phone:773-444-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.382654163WG0000X, 163WM0705X
IL209.014476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical