Provider Demographics
NPI:1336438555
Name:LEYVA-AQUENDE, VALENTINA (APN)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:LEYVA-AQUENDE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WATERS EDGE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6431
Mailing Address - Country:US
Mailing Address - Phone:630-495-8484
Mailing Address - Fax:
Practice Address - Street 1:580 WATERS EDGE STE 100
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6431
Practice Address - Country:US
Practice Address - Phone:630-495-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008471363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health