Provider Demographics
NPI:1114012416
Name:ZOLLINGER, LEIGH ANNE (CFNP, CEN)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:ZOLLINGER
Suffix:
Gender:F
Credentials:CFNP, CEN
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANNE
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4813 BRENTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9371
Mailing Address - Country:US
Mailing Address - Phone:757-483-1541
Mailing Address - Fax:
Practice Address - Street 1:996 SOUTH STATE ROAD
Practice Address - Street 2:IU HEALTH URGENT CARE
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-893-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002416696363LF0000X
KS53-45643363LF0000X
IN71005892A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161351Medicare ID - Type Unspecified