Healthcare Provider Details

I. General information

NPI: 1275510836
Provider Name (Legal Business Name): ANA DELIA LEIBECKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD SUITE NUMBER 204
DAYTON OH
45459-3859
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3598
US

V. Phone/Fax

Practice location:
  • Phone: 937-401-6822
  • Fax: 937-401-6935
Mailing address:
  • Phone: 937-914-7054
  • Fax: 937-522-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.12518-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9236898
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157670
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9301843
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.12518-NP
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN308764
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: