MEDICARE: DEBRA JO LEIH

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	163W00000X	Registered Nurse	18406	WY
2	363LF0000X	Family Nurse Practitioner	18406.0179	WY

Other Identifiers

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

General Provider Information

NPI Number	:	1861539793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA JO LEIH

Provider Business Mailing Address
First Line	:	208 N. BIGHORN
Second Line	:
City	:	MOORCROFT
State	:	WY
Zip	:	82721
Country	:	US
Telephone Number	:	307-756-3414
Fax Number	:	307-756-9237

Provider Business Practice Location Address
First Line	:	208 N. BIGHORN
Second Line	:
City	:	MOORCROFT
State	:	WY
Zip	:	82721
Country	:	US
Telephone Number	:	307-756-3414
Fax Number	:	307-756-9237

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	03/17/2018

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Directions to “ DEBRA JO LEIH ” Practice Location

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