MEDICARE: LESLIE LOPEZ DNP, FNP- BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041.455700	IL

General Provider Information

NPI Number	:	1154202661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE LOPEZ DNP, FNP- BC

Provider Business Mailing Address
First Line	:	1720 S MICHIGAN AVE APT 2311
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4855
Country	:	US
Telephone Number	:	708-910-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 S MICHIGAN AVE APT 2311
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4855
Country	:	US
Telephone Number	:	708-910-4099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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