Provider Demographics
NPI:1255682670
Name:LESIEWICZ, MORGAN TIFFANY (APN)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:TIFFANY
Last Name:LESIEWICZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MORGAN
Other - Middle Name:TIFFANY
Other - Last Name:DELFS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2112 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4277
Mailing Address - Country:US
Mailing Address - Phone:773-761-3001
Mailing Address - Fax:
Practice Address - Street 1:2112 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4277
Practice Address - Country:US
Practice Address - Phone:773-761-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041376616163W00000X
IL209009831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse