Healthcare Provider Details

I. General information

NPI: 1982201463
Provider Name (Legal Business Name): LEILANI REYES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST UNIT 408
EAST CHICAGO IN
46312-3078
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-398-9265
  • Fax: 219-398-9370
Mailing address:
  • Phone: 219-392-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022049
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013954A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: