MEDICARE: WENDY D LEEBER RN CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	200400445022	WV

General Provider Information

NPI Number	:	1134113962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY D LEEBER RN CFNP

Provider Business Mailing Address
First Line	:	3100 MACCORKLE AVE SE
Second Line	:	SUITE 301
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1223
Country	:	US
Telephone Number	:	304-388-5395
Fax Number	:	304-388-5398

Provider Business Practice Location Address
First Line	:	3100 MACCORKLE AVE SE
Second Line	:	SUITE 301
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1223
Country	:	US
Telephone Number	:	304-388-5395
Fax Number	:	304-388-5398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	12/31/2015

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