MISS AMANDA M LEISURE CPNP-AC/PC NPI 1154872653

NPI Information

NPI: 1154872653
Provider Name: MISS AMANDA M LEISURE, CPNP-AC/PC
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
11141 PARKVIEW PLAZA DR STE 210
FORT WAYNE, IN
ZIP 46845
Phone: (260) 266-5400
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MISS Amanda M Leisure, CPNP-AC/PC is a pediatrics nurse practitioner in Fort Wayne, IN. MISS Amanda M Leisure, CPNP-AC/PC NPI is 1154872653. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

11141 PARKVIEW PLAZA DR STE 210
FORT WAYNE, IN
ZIP 46845-714
Phone: (260) 266-5400
Fax: (260) 266-5409

The NPI 1154872653 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/19/2016 and was last updated on 10/10/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	71006767	INDIANA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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