Basic Information
| Provider Information | |||||||||
| NPI: | 1386987352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANEZ | ||||||||
| FirstName: | LEONOR | ||||||||
| MiddleName: | DE ASIS | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 22ND ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305755000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 WILLOW SPRINGS RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE HIGHLANDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605256537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305543456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209-010291 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.