Provider Demographics
NPI:1780286559
Name:KEENE, LEILA
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:KEENE
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 1:663 N SANGAMON ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6078
Mailing Address - Country:US
Mailing Address - Phone:312-953-6161
Mailing Address - Fax:323-316-2415
Practice Address - Street 1:663 N SANGAMON ST APT 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6078
Practice Address - Country:US
Practice Address - Phone:312-953-6161
Practice Address - Fax:323-316-2415
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker