Provider Demographics
NPI:1477554228
Name:FEATHER, LISA K (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:FEATHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W ROBINSON
Mailing Address - Street 2:
Mailing Address - City:WAYNE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62895-9483
Mailing Address - Country:US
Mailing Address - Phone:618-895-3181
Mailing Address - Fax:618-895-3035
Practice Address - Street 1:1601 W ROBINSON
Practice Address - Street 2:
Practice Address - City:WAYNE CITY
Practice Address - State:IL
Practice Address - Zip Code:62895-9483
Practice Address - Country:US
Practice Address - Phone:618-895-3181
Practice Address - Fax:618-895-3035
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-000778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCE9335OtherRR GROUP NUMBER
ILP00393085OtherRR MEDICARE NUMBER
ILK14521Medicare PIN
ILK36877Medicare PIN
ILP00393085OtherRR MEDICARE NUMBER