Individual
LISA M. FANTROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
24 CARRINGTON CT, HAZEL CREST, IL 60429-2517
(708) 922-9184
Mailing address
24 CARRINGTON CT, HAZEL CREST, IL 60429-2517
(708) 922-9184
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL5686021
MEDICARE PTAN
IL
Enumeration date
10/03/2006
Last updated
05/27/2025
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