Provider Demographics
NPI:1548735491
Name:CERVANTES, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S WATER ST STE 604
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1061
Mailing Address - Country:US
Mailing Address - Phone:217-423-6199
Mailing Address - Fax:217-233-7028
Practice Address - Street 1:132 S WATER ST STE 604
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1061
Practice Address - Country:US
Practice Address - Phone:217-423-6199
Practice Address - Fax:217-233-7028
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management