Provider Demographics
NPI:1073281127
Name:KRAFT, LEANNE M
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:KRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:MARIE
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHN
Mailing Address - Street 1:203 304 MAIN STREET S.
Mailing Address - Street 2:125
Mailing Address - City:AIRDRIE
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T4B3C3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 304 MAIN STREET S
Practice Address - Street 2:125
Practice Address - City:AIRDRIE
Practice Address - State:AB
Practice Address - Zip Code:T4B3C3
Practice Address - Country:CA
Practice Address - Phone:702-423-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCHN328808133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education