Provider Demographics
NPI:1265031629
Name:LEITNER-WISE, SUZANNE EVA (E-RYT500)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:EVA
Last Name:LEITNER-WISE
Suffix:
Gender:F
Credentials:E-RYT500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 K ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3692
Mailing Address - Country:US
Mailing Address - Phone:703-209-0049
Mailing Address - Fax:
Practice Address - Street 1:532 N WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2314
Practice Address - Country:US
Practice Address - Phone:703-209-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization