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NPI Code Detail

MEDICARE: MACKENNA LESLIE HILL FNP-C

MEDICARE: MACKENNA LESLIE HILL FNP-C
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
1363LF0000XFamily Nurse Practitioner209020227IL
2363LF0000XFamily Nurse Practitioner970833WI

General Provider Information

NPI Number : 1487297271
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENNA LESLIE HILL FNP-C
Provider Business Mailing Address
First Line : 3250 MIDLANE DR
Second Line :
City : WADSWORTH
State : IL
Zip : 60083-9459
Country : US
Telephone Number : 815-440-1032
Fax Number :
Provider Business Practice Location Address
First Line : 11002 W PARK PL
Second Line :
City : MILWAUKEE
State : WI
Zip : 53224-3615
Country : US
Telephone Number : 888-562-5442
Fax Number : 844-861-1929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2019
Last Update Date : 10/24/2019

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