Provider Demographics
NPI:1336318583
Name:LEITKO, VALERIE DIANNE
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:DIANNE
Last Name:LEITKO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:DIANNE
Other - Last Name:FYFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:680 S ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4113
Mailing Address - Country:US
Mailing Address - Phone:775-284-3386
Mailing Address - Fax:775-284-3389
Practice Address - Street 1:5975 S LOS ALTOS PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7699
Practice Address - Country:US
Practice Address - Phone:775-204-4000
Practice Address - Fax:775-204-4001
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical