Provider Demographics
NPI:1831793850
Name:WEYBRIGHT, LISA MARIE (APN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:WEYBRIGHT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1593
Mailing Address - Country:US
Mailing Address - Phone:309-712-4750
Mailing Address - Fax:
Practice Address - Street 1:8600 IL-91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-6157
Practice Address - Country:US
Practice Address - Phone:409-683-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily