Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209-002338 | IL |
NPI | 1033215728 |
---|---|
Provider Name | Mrs. Leslie Ann Sondeen Opila |
First Address | Downers Grove, IL 60516-2912 |
Second Address | Chicago, IL 60614-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 07/10/2011 |