Provider Demographics
NPI:1437616836
Name:LUELL, LEILANI GRUEZO (NP)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:GRUEZO
Last Name:LUELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10256 OLD GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2814
Mailing Address - Country:US
Mailing Address - Phone:262-551-4300
Mailing Address - Fax:
Practice Address - Street 1:10256 OLD GREEN BAY RD STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2814
Practice Address - Country:US
Practice Address - Phone:262-551-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041307510163W00000X
IL209018826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse