Provider Demographics
NPI:1245209998
Name:TORRESE, LYDIA RUTH (CNS)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:RUTH
Last Name:TORRESE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 GRANT STREET
Mailing Address - Street 2:ATTN ACCOUNTING DEPARTMENT
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-492-2885
Mailing Address - Fax:847-316-8723
Practice Address - Street 1:3200 GRANT STREET
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-492-2885
Practice Address - Fax:847-316-8723
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004513364S00000X
IL364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16227Medicare ID - Type Unspecified
IL210708Medicare ID - Type UnspecifiedGROUP