Healthcare Provider Details

I. General information

NPI: 1164833737
Provider Name (Legal Business Name): REBECCA LEONHARDT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W. COURT STREET
KANKAKEE IL
60468
US

IV. Provider business mailing address

1000 REMINGTON BLVD STE 100
BOLINGBROOK IL
60440-4707
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2200
  • Fax: 815-937-2258
Mailing address:
  • Phone:
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011488
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: