Healthcare Provider Details

I. General information

NPI: 1952116238
Provider Name (Legal Business Name): RIJADA LELIC AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST STE 640
EVANSTON IL
60201-1780
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1410
  • Fax: 847-869-0520
Mailing address:
  • Phone: 847-982-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031814
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.031814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: