Provider Demographics
NPI:1801555818
Name:LEUNG, DARLENE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 EAST CHICAGO AVENUE
Mailing Address - Street 2:BOX 51
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:773-519-2897
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 51
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-3550
Practice Address - Fax:312-227-9642
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024906363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty