Provider Demographics
NPI:1467776898
Name:HENGEN, LISA LYNN (DNP, APRN, CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:HENGEN
Suffix:
Gender:F
Credentials:DNP, APRN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34121 N US HIGHWAY 45 STE 210
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1774
Practice Address - Country:US
Practice Address - Phone:224-602-3472
Practice Address - Fax:630-358-6856
Is Sole Proprietor?:No
Enumeration Date:2010-03-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010485363LF0000X
WVAPRN99740363LP0808X
PASP024093363LP0808X
IL209022327363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031576690009Medicaid