Healthcare Provider Details

I. General information

NPI: 1730632316
Provider Name (Legal Business Name): ALENA V LEONOVA APN. NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALENA LIAONAVA FNP

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 75TH ST SUITE 303
NAPERVILLE IL
60540-9336
US

IV. Provider business mailing address

1331 W 75TH ST SUITE 303
NAPERVILLE IL
60540-9336
US

V. Phone/Fax

Practice location:
  • Phone: 630-652-0606
  • Fax:
Mailing address:
  • Phone: 630-652-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: