Provider Demographics
NPI:1043320401
Name:LEITER, KAREN SUE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:LEITER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1825
Mailing Address - Country:US
Mailing Address - Phone:231-796-2801
Mailing Address - Fax:
Practice Address - Street 1:201 LINDEN ST
Practice Address - Street 2:PHYSICIAN HEALTH SERVICES
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1825
Practice Address - Country:US
Practice Address - Phone:231-796-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4984385Medicaid