Provider Demographics
NPI:1396338661
Name:SERNIAS, LELEINE ARENGA
Entity type:Individual
Prefix:
First Name:LELEINE
Middle Name:ARENGA
Last Name:SERNIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W VICTORIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6700
Mailing Address - Country:US
Mailing Address - Phone:312-513-1485
Mailing Address - Fax:
Practice Address - Street 1:301 E FOREST LN
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-7533
Practice Address - Country:US
Practice Address - Phone:312-513-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041294294163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology