Provider Demographics
NPI:1871961813
Name:MOORE-HICKS, LESLIE DY-ANNE (CNM)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DY-ANNE
Last Name:MOORE-HICKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:DY-ANNE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:8444 S SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6023
Mailing Address - Country:US
Mailing Address - Phone:773-983-2536
Mailing Address - Fax:
Practice Address - Street 1:17 N STATE ST FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3384
Practice Address - Country:US
Practice Address - Phone:312-592-6800
Practice Address - Fax:312-592-6801
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013009363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife