Healthcare Provider Details

I. General information

NPI: 1518744788
Provider Name (Legal Business Name): EVAN LEYBA DNAP-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 200
INDIANAPOLIS IN
46237-8632
US

IV. Provider business mailing address

4216 BOWMAN RD APT C23
LITTLE ROCK AR
72210-2376
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-2955
  • Fax:
Mailing address:
  • Phone: 219-781-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28209957A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number217727
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: