Basic Information
| Provider Information | |||||||||
| NPI: | 1811101975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEHNY | ||||||||
| FirstName: | LEANNE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479608182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745837111 | ||||||||
| FaxNumber: | 5745831774 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479608182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745837111 | ||||||||
| FaxNumber: | 5745831774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 28124069 | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 200518850 | 05 | IN | MEDICAID |