Provider Demographics
NPI:1366839532
Name:HERRANZ, LISA SHIRA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SHIRA
Last Name:HERRANZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2608
Mailing Address - Country:US
Mailing Address - Phone:734-476-0513
Mailing Address - Fax:
Practice Address - Street 1:5125 N KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2608
Practice Address - Country:US
Practice Address - Phone:734-476-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.361121163WC1500X
ILL-45569163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health