Provider Demographics
NPI:1922709575
Name:LIGHTBOURNE, KARA JANELLE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:JANELLE
Last Name:LIGHTBOURNE
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 1:208 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1026
Mailing Address - Country:US
Mailing Address - Phone:630-550-2992
Mailing Address - Fax:
Practice Address - Street 1:208 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1026
Practice Address - Country:US
Practice Address - Phone:630-550-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily