Provider Demographics
NPI:1679090112
Name:LYLE, DONNA LEE (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:LYLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHADY NOOK UNIT C
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60421
Mailing Address - Country:US
Mailing Address - Phone:815-210-3088
Mailing Address - Fax:
Practice Address - Street 1:1 SHADYNOOK UNIT C
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IL
Practice Address - Zip Code:60421
Practice Address - Country:US
Practice Address - Phone:815-210-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041311399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse