Healthcare Provider Details

I. General information

NPI: 1649974981
Provider Name (Legal Business Name): LEIGH GREEN APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

23585 W BRIAR TER
ANTIOCH IL
60002-2103
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-0472
  • Fax:
Mailing address:
  • Phone: 630-988-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209026965
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.026965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: