Provider Demographics
NPI:1023382215
Name:LEAVENDUSKY, TOBY EDWARD (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:EDWARD
Last Name:LEAVENDUSKY
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16809 R RD
Mailing Address - Street 2:
Mailing Address - City:MAYETTA
Mailing Address - State:KS
Mailing Address - Zip Code:66509-8954
Mailing Address - Country:US
Mailing Address - Phone:785-845-6043
Mailing Address - Fax:
Practice Address - Street 1:16809 R RD
Practice Address - Street 2:
Practice Address - City:MAYETTA
Practice Address - State:KS
Practice Address - Zip Code:66509-8954
Practice Address - Country:US
Practice Address - Phone:785-845-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-89907-022163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management