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General NPI Number Information
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NPI Number | 1508343161
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Entity Type | Individual
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Provider Name | ANGELINA M LEITSCHUH NP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 1181 S STATE ROUTE 157 STE 200
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3897
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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Provider Business Mailing Address
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Address Line | 1188 SOUTH STATE ROUTE 157
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-692-5900
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Fax | 618-692-5901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017871
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License Number State | IL
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