Healthcare Provider Details

I. General information

NPI: 1144130469
Provider Name (Legal Business Name): HAILEY JO LEONARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WISCONSIN AMERICAN DR
FOND DU LAC WI
54937-2999
US

IV. Provider business mailing address

6456 BONNIE VIEW RD
PICKETT WI
54964-9505
US

V. Phone/Fax

Practice location:
  • Phone: 920-907-7000
  • Fax:
Mailing address:
  • Phone: 920-392-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1900133
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: