Provider Demographics
NPI:1215721113
Name:GRAVES, LEANDRA REGINA
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:REGINA
Last Name:GRAVES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CATON FARM RD TRLR 95
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3919
Mailing Address - Country:US
Mailing Address - Phone:708-994-4341
Mailing Address - Fax:708-994-4341
Practice Address - Street 1:300 CATON FARM RD TRLR 95
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3919
Practice Address - Country:US
Practice Address - Phone:708-994-4341
Practice Address - Fax:708-994-4341
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 374U00000X
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide