Provider Demographics
NPI:1821695487
Name:LEMUS, ADA YANCI I (FNP)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:YANCI
Last Name:LEMUS
Suffix:I
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:YANCI
Other - Last Name:LEMUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4931 W AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2449
Mailing Address - Country:US
Mailing Address - Phone:312-523-9903
Mailing Address - Fax:
Practice Address - Street 1:1276 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2089
Practice Address - Country:US
Practice Address - Phone:312-337-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily