Healthcare Provider Details

I. General information

NPI: 1134949308
Provider Name (Legal Business Name): JUNE EUNJEONG LEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WEBER RD
CREST HILL IL
60403-0928
US

IV. Provider business mailing address

2222 WEBER RD
CREST HILL IL
60403-0928
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-9714
  • Fax: 815-744-5137
Mailing address:
  • Phone: 815-741-9714
  • Fax: 815-744-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: