Healthcare Provider Details

I. General information

NPI: 1316342215
Provider Name (Legal Business Name): JULIE LEUNG C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7500
  • Fax:
Mailing address:
  • Phone: 312-413-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209.011965
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.011965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: