Individual
LISA ANNE WERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
(872) 588-3021
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
(872) 588-3001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-005553
IL
363A00000X
Physician Assistant
Primary
085005553
IL
363A00000X
Physician Assistant
2378
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085005553
STATE LICENSE
IL
01
—
1111165
SPECIALTY BOARDS
IL
01
—
385004177
CS LICENSE
IL
Enumeration date
08/19/2013
Last updated
03/07/2023
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