Provider Demographics
NPI:1275510836
Name:LEIBECKE, ANA DELIA (FNP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:DELIA
Last Name:LEIBECKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:937-914-7054
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE NUMBER 204
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3859
Practice Address - Country:US
Practice Address - Phone:937-401-6822
Practice Address - Fax:937-401-6935
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9236898363LF0000X
MDR157670363LF0000X
OHRN308764163W00000X
FLARNP9301843363LF0000X
OHCOA.12518-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075893Medicaid
OH0075893Medicaid