Healthcare Provider Details

I. General information

NPI: 1154202661
Provider Name (Legal Business Name): LESLIE LOPEZ DNP, FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S MICHIGAN AVE APT 2311
CHICAGO IL
60616-4855
US

IV. Provider business mailing address

1720 S MICHIGAN AVE APT 2311
CHICAGO IL
60616-4855
US

V. Phone/Fax

Practice location:
  • Phone: 708-910-4099
  • Fax:
Mailing address:
  • Phone: 708-910-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.455700
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: