Provider Demographics
NPI:1588748420
Name:LESHEN, RUTH (ANP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:LESHEN
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 1:375 N WALL ST
Mailing Address - Street 2:SUITE P510
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-935-1787
Mailing Address - Fax:815-935-2248
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:SUITE P510
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-935-1787
Practice Address - Fax:815-935-2248
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP68087Medicare UPIN
ILK03339Medicare ID - Type Unspecified