Lisa D'Andrea, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085-001596 Issued in IL

Practice address

1800 Hollister Dr
Suite 102
Libertyville, IL 60048-5263

Phone

(847) 680-3666

Fax

(847) 680-3994

NPI assigned

Sep 22, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289088000000",
    "number": "1891781142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "SUITE 102",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-680-3666",
            "fax_number": "847-680-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "SUITE 102",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-680-3666",
            "fax_number": "847-680-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'ANDREA",
        "first_name": "LISA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-22",
        "last_updated": "2010-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-001596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.