Healthcare Provider Details

I. General information

NPI: 1811101975
Provider Name (Legal Business Name): LEANNE P BEHNY C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 6TH ST
MONTICELLO IN
47960-8182
US

IV. Provider business mailing address

720 S 6TH ST
MONTICELLO IN
47960-8182
US

V. Phone/Fax

Practice location:
  • Phone: 574-583-7111
  • Fax: 574-583-1774
Mailing address:
  • Phone: 574-583-7111
  • Fax: 574-583-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28124069
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: