Provider Demographics
NPI:1851973325
Name:PATEL, LISA (FNP-BC, PHMNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:FNP-BC, PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1140
Mailing Address - Country:US
Mailing Address - Phone:224-425-6179
Mailing Address - Fax:
Practice Address - Street 1:1568 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1140
Practice Address - Country:US
Practice Address - Phone:224-425-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023287363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily