Provider Demographics
NPI:1053354472
Name:LEAKER, CYNTHIA H (MSN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:H
Last Name:LEAKER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:H
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:660 N WESTMORELAND RD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-243-5600
Mailing Address - Fax:
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:LAKE FOREST HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:312-259-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF13702363LF0000X
IL209.008793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00137020Medicaid
IL00137020Medicaid
IL00137020Medicare PIN
CAQ53496Medicare UPIN
IL00137020Medicaid
CA00137020Medicaid