Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | PENDING | IL |
NPI | 1063990588 |
---|---|
Provider Name | Lisa Hammons |
First Address | Olympia Fields, IL 60461-1211 |
Second Address | Orland Park, IL 60462-2630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |