Healthcare Provider Details

I. General information

NPI: 1245164375
Provider Name (Legal Business Name): GARY LEINON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 COOLIDGE AVE
RHINELANDER WI
54501-2814
US

IV. Provider business mailing address

665 COOLIDGE AVE
RHINELANDER WI
54501-2814
US

V. Phone/Fax

Practice location:
  • Phone: 715-365-9120
  • Fax: 715-365-9124
Mailing address:
  • Phone: 715-365-9120
  • Fax: 715-365-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number188606-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: