Provider Demographics
NPI:1578685558
Name:PETERS, LISY JOY (NP)
Entity type:Individual
Prefix:MRS
First Name:LISY
Middle Name:JOY
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CITADEL CT
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6489
Mailing Address - Country:US
Mailing Address - Phone:847-902-6663
Mailing Address - Fax:
Practice Address - Street 1:735 CITADEL CT
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6489
Practice Address - Country:US
Practice Address - Phone:847-902-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005628363LP0200X
IL041249037163W00000X
IL209003055364S00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN