Provider Demographics
NPI:1215423660
Name:PERSINO, KAYLEIGH (ANP)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:PERSINO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE STE 629
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3822
Mailing Address - Country:US
Mailing Address - Phone:312-641-6228
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 629
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3822
Practice Address - Country:US
Practice Address - Phone:815-347-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily