Provider Demographics
NPI:1326631292
Name:SIANEZ, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:SIANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4207
Mailing Address - Country:US
Mailing Address - Phone:773-679-0943
Mailing Address - Fax:
Practice Address - Street 1:7124 W 83RD ST UNIT C
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-4034
Practice Address - Country:US
Practice Address - Phone:708-788-5088
Practice Address - Fax:708-575-7177
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030237363LF0000X
IL041436654163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health