MEDICARE: MS. VALERIE DIANNE LEITKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA1097	NV

General Provider Information

NPI Number	:	1336318583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE DIANNE LEITKO

Provider Business Mailing Address
First Line	:	680 S ROCK BLVD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-4113
Country	:	US
Telephone Number	:	775-284-3386
Fax Number	:	775-284-3389

Provider Business Practice Location Address
First Line	:	5975 S LOS ALTOS PKWY
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89436-7699
Country	:	US
Telephone Number	:	775-204-4000
Fax Number	:	775-204-4001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	03/17/2021

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