Basic Information
Provider Information
NPI: 1245894054
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LENO
FirstName: IRYNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9977 WOODS DR # 300
Address2:  
City: SKOKIE
State: IL
PostalCode: 600771057
CountryCode: US
TelephoneNumber: 8476663854
FaxNumber: 8476631015
Practice Location
Address1: 9977 WOODS DR # 300
Address2:  
City: SKOKIE
State: IL
PostalCode: 600771057
CountryCode: US
TelephoneNumber: 8476663854
FaxNumber: 8476631015
Other Information
ProviderEnumerationDate: 04/26/2019
LastUpdateDate: 01/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X209019006ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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