Active NPI
Lisa Gazdziak
- Family Nurse Practitioner
- Crystal Lake, IL
National Provider Identifier
1386310605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209023595
- Practice address
- 1305 Randall Rd
Crystal Lake, IL 60014-8601 - Phone
- (815) 356-0386
- NPI assigned
- Aug 17, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209023595 | IL | Primary |
Addresses
Primary practice location
1305 Randall Rd
Crystal Lake, IL 60014-8601
Mailing address
1305 Randall Rd
Crystal Lake, IL 60014-8601
Phone (815) 356-0386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632182400000",
"number": "1386310605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 RANDALL RD",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600148601",
"telephone_number": "815-356-0386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 RANDALL RD",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600148601",
"telephone_number": "815-356-0386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAZDZIAK",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-17",
"last_updated": "2021-09-21",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209023595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.