Provider Demographics
NPI:1568684348
Name:MANDIGMA, LEONIDA S (RN)
Entity Type:Individual
Prefix:MS
First Name:LEONIDA
Middle Name:S
Last Name:MANDIGMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 HANBURY DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 W HIGGINS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2009
Practice Address - Country:US
Practice Address - Phone:773-774-5460
Practice Address - Fax:773-774-5461
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health