Individual
LESLIE BASSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(312) 836-3720
Mailing address
401 N MICHIGAN AVE STE 1200, CHICAGO, IL 60611-4264
(312) 836-3720
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209012147
IL
363LG0600X
Gerontology Nurse Practitioner
209012147
IL
Other
Enumeration date
11/26/2014
Last updated
12/13/2021
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