Healthcare Provider Details

I. General information

NPI: 1649060328
Provider Name (Legal Business Name): ALLISON AUDREY LEIGHTNER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PARADISE DR
WEST BEND WI
53095-9795
US

IV. Provider business mailing address

811 KINGS RIDGE CT W
WEST BEND WI
53090-9188
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-3451
  • Fax:
Mailing address:
  • Phone: 715-308-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16101-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: