Provider Demographics
NPI:1023719499
Name:MOY, LISA ELAINE (BSN, RN, IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:MOY
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 COMMODORE LN UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5453
Mailing Address - Country:US
Mailing Address - Phone:847-347-4057
Mailing Address - Fax:
Practice Address - Street 1:1520 COMMODORE LN UNIT 6
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-5453
Practice Address - Country:US
Practice Address - Phone:847-347-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-27048163WL0100X
IL041250289163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant