MEDICARE: MRS. ANDREA RENEE LEITSCHUH RN

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	RN.369681	OH

General Provider Information

NPI Number	:	1912495714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA RENEE LEITSCHUH RN

Provider Business Mailing Address
First Line	:	5021 LINCREST PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2738
Country	:	US
Telephone Number	:	934-604-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR STE 201
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	934-384-0580
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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