Healthcare Provider Details

I. General information

NPI: 1073281127
Provider Name (Legal Business Name): LEANNE M KRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNE MARIE VOGEL CHN

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 304 MAIN STREET S 125
AIRDRIE AB
T4B3C3
CA

IV. Provider business mailing address

203 304 MAIN STREET S. 125
AIRDRIE ALBERTA
T4B3C3
CA

V. Phone/Fax

Practice location:
  • Phone: 702-423-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberCHN328808
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: