Provider Demographics
NPI:1700470986
Name:CHASE, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LINDEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1506 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6806
Mailing Address - Country:US
Mailing Address - Phone:630-221-1400
Mailing Address - Fax:
Practice Address - Street 1:1506 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6806
Practice Address - Country:US
Practice Address - Phone:630-221-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041302104163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)