MEDICARE: LESLIE S MCILVRIED NP

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	363L00000X	Nurse Practitioner	242197	MA
2	363LF0000X	Family Nurse Practitioner	242197	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C434	OTHER	MA	HARVARD PILGRIM
3	NP3266	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1225098445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE S MCILVRIED NP

Provider Business Mailing Address
First Line	:	706 STEEPLECHASE RD
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-4705
Country	:	US
Telephone Number	:	508-631-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 PARK ST
Second Line	:	SUITE #300
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4861
Country	:	US
Telephone Number	:	630-416-6056
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/14/2016

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