Individual
LISA K ANDERSON-SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, BC
Contact information
Practice address
MACNEAL TRINITY MEDICAL CETNER, 3249 OAK PARK AVENUE, BERWYN, IL 60402
(708) 738-9100
Mailing address
420 E WATERSIDE DR UNIT 3910, CHICAGO, IL 60601-8026
(312) 636-4908
Taxonomy
Speciality
Code
Description
License number
State
174V00000X
Clinical Ethicist
Primary
209001980
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53653162873A
STATE DRIVERS LICENCE
IL
Enumeration date
07/27/2020
Last updated
07/27/2020
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