Provider Demographics
NPI:1235228388
Name:LEONARD, ANTHONY GEORGE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GEORGE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-0000
Mailing Address - Country:US
Mailing Address - Phone:307-332-2189
Mailing Address - Fax:307-332-2803
Practice Address - Street 1:175 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2803
Practice Address - Country:US
Practice Address - Phone:307-332-2189
Practice Address - Fax:307-332-2803
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY142062300Medicaid