Healthcare Provider Details

I. General information

NPI: 1578654422
Provider Name (Legal Business Name): CARLA DAWN LEUSCHEN MSN, CNS, FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD MEDICAL SVC/PRIMARY CARE-111
MURFREESBORO TN
37129-1237
US

IV. Provider business mailing address

3400 LEBANON RD ATTN: FIRM B
MURFREESBORO TN
37129-1237
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-6111
  • Fax:
Mailing address:
  • Phone: 615-225-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number515308
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1857
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000012826
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: