Provider Demographics
NPI:1083369094
Name:LEINENBACH, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LEINENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2102
Mailing Address - Country:US
Mailing Address - Phone:812-639-8460
Mailing Address - Fax:
Practice Address - Street 1:1015 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2102
Practice Address - Country:US
Practice Address - Phone:812-639-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program