Provider Demographics
NPI:1861689143
Name:LESKO, CAROL M (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:M
Last Name:LESKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:632 E CHAIN OF ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2805
Mailing Address - Country:US
Mailing Address - Phone:618-567-3566
Mailing Address - Fax:
Practice Address - Street 1:270 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2004
Practice Address - Country:US
Practice Address - Phone:618-498-2273
Practice Address - Fax:618-639-7997
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO18209363LW0102X
IL209003178363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO118209Medicaid
IL209003178Medicaid