Individual
LISA MARIE FONTANINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.026950
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209026950
—
IL
Enumeration date
05/15/2023
Last updated
09/04/2025
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