Individual
ANGELINA M LEITSCHUH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1181 S STATE ROUTE 157 STE 200, EDWARDSVILLE, IL 62025-3897
(618) 628-8211
(618) 628-0883
Mailing address
1188 SOUTH STATE ROUTE 157, EDWARDSVILLE, IL 62025
(618) 692-5900
(618) 692-5901
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017871
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209017871
IL STATE LICENSE
IL
Enumeration date
07/25/2018
Last updated
08/17/2022
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