Provider Demographics
NPI:1164998332
Name:GRESKOWIAK, LESLIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GRESKOWIAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SALT CREEK LN STE 301
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2903
Mailing Address - Country:US
Mailing Address - Phone:331-221-2550
Mailing Address - Fax:
Practice Address - Street 1:8 SALT CREEK LN STE 301
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2903
Practice Address - Country:US
Practice Address - Phone:331-221-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty