Provider Demographics
NPI:1578523478
Name:VEGA, LETA MARIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LETA
Middle Name:MARIE
Last Name:VEGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W RAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2315
Mailing Address - Country:US
Mailing Address - Phone:847-221-4900
Mailing Address - Fax:847-221-4996
Practice Address - Street 1:1051 W RAND RD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2315
Practice Address - Country:US
Practice Address - Phone:847-221-4900
Practice Address - Fax:847-221-4996
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277-000461367A00000X
IL209005087176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005087OtherSTATE LICENSE