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NPI Code Detail

MEDICARE: FAYE E LEATHERMAN

MEDICARE: FAYE E LEATHERMAN
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
1367500000XCertified Registered Nurse Anesthetist51225030WI

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 : 1932159506
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAYE E LEATHERMAN
Provider Business Mailing Address
First Line : 3420 JACKSON ST
Second Line : SUITE E
City : OSHKOSH
State : WI
Zip : 54901-8144
Country : US
Telephone Number : 920-426-2211
Fax Number : 920-426-2231
Provider Business Practice Location Address
First Line : 500 S OAKWOOD RD
Second Line :
City : OSHKOSH
State : WI
Zip : 54904-7944
Country : US
Telephone Number : 920-223-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/09/2010

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Directions to “ FAYE E LEATHERMAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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