Provider Demographics
NPI:1952688459
Name:RUBECK, LESLIE S (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:RUBECK
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:M
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 S WAUKEGAN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2619
Mailing Address - Country:US
Mailing Address - Phone:847-295-0433
Mailing Address - Fax:855-332-1934
Practice Address - Street 1:840 S WAUKEGAN RD STE 208
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2619
Practice Address - Country:US
Practice Address - Phone:847-295-0433
Practice Address - Fax:855-332-1934
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009238367A00000X
CA209009238367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife