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NPI Code Detail

MEDICARE: ALOHA PENAFLOR LEBLANC

MEDICARE: ALOHA PENAFLOR LEBLANC
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
1363LP2300XPrimary Care Nurse Practitioner209016903IL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner209016903IL

General Provider Information

NPI Number : 1437665411
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALOHA PENAFLOR LEBLANC
Provider Business Mailing Address
First Line : 2579 W MONTROSE AVE APT 3S
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1518
Country : US
Telephone Number : 312-371-2816
Fax Number :
Provider Business Practice Location Address
First Line : 5215 N CALIFORNIA AVE STE F101
Second Line :
City : CHICAGO
State : IL
Zip : 60625-0035
Country : US
Telephone Number : 773-561-5809
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2017
Last Update Date : 08/13/2020

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Directions to “ ALOHA PENAFLOR LEBLANC ” Practice Location

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