Basic Information
| Provider Information | |||||||||
| NPI: | 1225094717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEISCHNER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 386 N LARCH AVE | ||||||||
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| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601262314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735513724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 E BRUSH HILL RD | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312211000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209005879 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.