Individual
LERONE FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9047 CENTRAL AVE, MORTON GROVE, IL 60053-2565
(847) 966-8186
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041409728
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209-028661
IL
Other
Enumeration date
08/22/2021
Last updated
08/28/2024
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