Healthcare Provider Details

I. General information

NPI: 1033215728
Provider Name (Legal Business Name): LESLIE ANN SONDEEN OPILA RN/APN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN SONDEEN OPILA RN/APN/NP

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

6613 FAIRMOUNT AVE
DOWNERS GROVE IL
60516-2912
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4929
  • Fax: 773-880-3374
Mailing address:
  • Phone: 630-492-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number41-299428
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-002338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: