Individual
MS. LISA REICHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, APRN, CWOCN
Contact information
Practice address
15915 S CRYSTAL CREEK DR STE 8, HOMER GLEN, IL 60491-9284
(708) 400-8063
Mailing address
325 S PARK RD, LA GRANGE, IL 60525-2128
(708) 579-3191
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
209-005646
IL
364S00000X
Clinical Nurse Specialist
Primary
277.000713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277.000713
STATE OF ILLINOIS FPA APRN LICENSE
IL
Enumeration date
05/09/2007
Last updated
03/20/2025
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