Provider Demographics
NPI:1063646206
Name:OTIENO, LEILA ADHIAMBO (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:ADHIAMBO
Last Name:OTIENO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:ADHIAMBO
Other - Last Name:OTIENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:5112 MORNING DOVE WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9844
Mailing Address - Country:US
Mailing Address - Phone:443-768-0423
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3100
Practice Address - Country:US
Practice Address - Phone:570-321-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty