Provider Demographics
NPI:1184182669
Name:THOMAS-CRAFT, LISA D (MSN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:THOMAS-CRAFT
Suffix:
Gender:F
Credentials:MSN-FNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:THOMAS-CRAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN-FNP-BC
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:6345 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1133
Practice Address - Country:US
Practice Address - Phone:844-725-5238
Practice Address - Fax:708-346-8285
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017697207Q00000X
IL209.017697363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine