Provider Demographics
NPI:1639546294
Name:CORRAL, LILIA (APN)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:CORRAL
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 1:1102 E DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1412
Mailing Address - Country:US
Mailing Address - Phone:773-615-6998
Mailing Address - Fax:
Practice Address - Street 1:2050 CLAIRE CT
Practice Address - Street 2:JOURNEYCARE
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7635
Practice Address - Country:US
Practice Address - Phone:847-467-7423
Practice Address - Fax:847-556-1715
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1639546294OtherNPI