Healthcare Provider Details

I. General information

NPI: 1033476080
Provider Name (Legal Business Name): LETASHA LEWIS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20280 GOVERNORS HWY STE 102
OLYMPIA FIELDS IL
60461-1068
US

IV. Provider business mailing address

900 OGDEN AVE # 335
DOWNERS GROVE IL
60515-2829
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-0388
  • Fax: 773-234-0394
Mailing address:
  • Phone: 773-234-0388
  • Fax: 773-234-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001315
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number277001315
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number277001315
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: