Individual
LISA ANNE BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 GLENWOOD AVE STE 210, JOLIET, IL 60435-5498
(630) 473-8737
Mailing address
818 N BROAD ST, GRIFFITH, IN 46319-2231
(219) 746-0764
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.360286
IL
363LW0102X
Women's Health Nurse Practitioner
Primary
209.026405
IL
Other
Enumeration date
01/27/2023
Last updated
01/27/2023
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