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General NPI Number Information
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NPI Number | 1225098445
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Entity Type | Individual
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Provider Name | LESLIE S MCILVRIED NP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 1755 PARK ST SUITE #300
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City | NAPERVILLE
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State | IL
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Zip | 60563-4861
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Country | US
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Telephone | 630-416-6056
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Fax |
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Provider Business Mailing Address
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Address Line | 706 STEEPLECHASE RD
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City | SAINT CHARLES
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State | IL
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Zip | 60174-4705
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Country | US
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Telephone | 508-631-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 242197
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 242197
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License Number State | MA
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