Basic Information
| Provider Information | |||||||||
| NPI: | 1073925095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEINENBACH | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1028 | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475471028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129961088 | ||||||||
| FaxNumber: | 8129968497 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 SCOTT ROLEN DR | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475462700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124825656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2014 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 28190524A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 163W00000X | 28190524A | IN | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 71005075A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.