Provider Demographics
NPI:1811362197
Name:VISAK, ANNA-MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA-MICHELLE
Middle Name:
Last Name:VISAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 N TRUE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2677
Mailing Address - Country:US
Mailing Address - Phone:219-381-0695
Mailing Address - Fax:
Practice Address - Street 1:2171 W EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5625
Practice Address - Country:US
Practice Address - Phone:630-317-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28214854A163W00000X
IL209013448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse