Provider Demographics
NPI:1114678869
Name:MAYER, LEANN J (DNP, AGNP-C, RN, CNE)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:J
Last Name:MAYER
Suffix:
Gender:F
Credentials:DNP, AGNP-C, RN, CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4697
Mailing Address - Country:US
Mailing Address - Phone:260-483-9081
Mailing Address - Fax:
Practice Address - Street 1:1145 W 300 N
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9716
Practice Address - Country:US
Practice Address - Phone:260-227-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28131765A363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health