Basic Information
| Provider Information | |||||||||
| NPI: | 1942563119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEITTEN | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | BURNS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SULLYS TRL | ||||||||
| Address2: | BLDG 20 | ||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145344552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855447979 | ||||||||
| FaxNumber: | 5855447901 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 SULLYS TRL | ||||||||
| Address2: | BLDG 20 | ||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145344552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855447979 | ||||||||
| FaxNumber: | 5855447901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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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 | 363LA2200X | F305685 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163W00000X | 601931 | NY | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 03947844 | 05 | NY | MEDICAID |