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General NPI Number Information
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NPI Number | 1932636339
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Entity Type | Organization
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Legal Business Name | LESLIE MCILVRIED APRN BC LLC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1755 PARK ST
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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 | 630-983-8920
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Fax | 630-983-4839
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Provider Business Mailing Address
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Address Line | 1755 PARK ST
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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 | 630-983-8920
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Fax | 630-983-4839
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LESLIE MCILVRIED
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Credential | APRN BC
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Telephone | 630-983-8920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 041410686
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License Number State | IL
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