Basic Information
| Provider Information | |||||||||
| NPI: | 1831595735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | LEYNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1616 FAITHORN AVE | ||||||||
| Address2: | |||||||||
| City: | CRETE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604173219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089356947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2320 THORNTON LANSING RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604382116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732334100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2014 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209012051 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.