Healthcare Provider Details

I. General information

NPI: 1265971204
Provider Name (Legal Business Name): VENUS LIEZL BASNILLO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W BELMONT AVE
CHICAGO IL
60641-4127
US

IV. Provider business mailing address

5425 W BELMONT AVE
CHICAGO IL
60641-4127
US

V. Phone/Fax

Practice location:
  • Phone: 312-702-1313
  • Fax: 844-269-6602
Mailing address:
  • Phone: 312-702-1313
  • Fax: 844-269-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209015653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: