Provider Demographics
NPI:1124326822
Name:KANUS, LESIA (ANP)
Entity type:Individual
Prefix:
First Name:LESIA
Middle Name:
Last Name:KANUS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KANUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:840 S. WOOD ST.
Mailing Address - Street 2:SUITE 440
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-7704
Mailing Address - Fax:312-413-8283
Practice Address - Street 1:840 S. WOOD ST. UNIVERSITY OF ILLINOIS MEDICAL CENTER
Practice Address - Street 2:SUITE 440
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-7704
Practice Address - Fax:312-413-8283
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-190456363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37-6000511Medicare UPIN