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NPI Code Detail

MEDICARE: MYRNA LEAL PMHNP-BC, APNP

MEDICARE: MYRNA LEAL PMHNP-BC, APNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1745133WI
2363L00000XNurse Practitioner17451-33WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497611008
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRNA LEAL PMHNP-BC, APNP
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 1220 DEWEY AVE
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-2504
Country : US
Telephone Number : 414-454-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2025
Last Update Date : 05/12/2026

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Directions to “ MYRNA LEAL PMHNP-BC, APNP” Practice Location

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