Healthcare Provider Details

I. General information

NPI: 1033609508
Provider Name (Legal Business Name): LINDSEY GRADONE APN-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY DIONNE LEIB

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

1607 E 50TH PL APT 3B
CHICAGO IL
60615-6134
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 512-913-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20917591
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041410049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: