MEDICARE: CHARLES LENNES

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	363LP0200X	Pediatric Nurse Practitioner	209.033465	IL

General Provider Information

NPI Number	:	1346109410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LENNES

Provider Business Mailing Address
First Line	:	6110 N KENMORE AVE APT 510
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 N KENMORE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2750
Country	:	US
Telephone Number	:	815-334-7589
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ CHARLES LENNES ” Practice Location

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