Provider Demographics
NPI:1215294475
Name:CACOVEAN, LEEANN MICHELLE (MSN, ACNP)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:MICHELLE
Last Name:CACOVEAN
Suffix:
Gender:F
Credentials:MSN, ACNP
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:MICHELLE
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:TOWER 2 - SUITE 400
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-719-4799
Mailing Address - Fax:630-963-7420
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 2 - SUITE 400
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-719-4799
Practice Address - Fax:630-963-7420
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009474363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care