Provider Demographics
NPI:1467624775
Name:LEWIS, LAUREEN (APN)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 ARTAIUS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5231
Mailing Address - Country:US
Mailing Address - Phone:224-440-2173
Mailing Address - Fax:
Practice Address - Street 1:1512 ARTAIUS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5231
Practice Address - Country:US
Practice Address - Phone:478-461-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001152364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult