Provider Demographics
NPI:1194928580
Name:SCHRAMEK, LISA L (APN-BC, FPA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:SCHRAMEK
Suffix:
Gender:F
Credentials:APN-BC, FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MATLOCK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1034
Mailing Address - Country:US
Mailing Address - Phone:573-265-0448
Mailing Address - Fax:573-265-0449
Practice Address - Street 1:207 MATLOCK DR
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1034
Practice Address - Country:US
Practice Address - Phone:573-265-4889
Practice Address - Fax:573-265-0449
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005405363LA2200X, 363LA2200X
IL277000331363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILIL3374063Medicare PIN
IL$$$$$$$$$001Medicaid
MOP53031Medicare UPIN