Individual
CHIBUZO LASISI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 N VINE ST UNIT 100A, NEW LENOX, IL 60451-1652
(815) 435-4055
Mailing address
4749 LINCOLN MALL DR STE 202H, MATTESON, IL 60443-3826
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
277004019
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277004019
IL
Other
Enumeration date
02/10/2022
Last updated
03/21/2026
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