Provider Demographics
NPI:1346473089
Name:LEONTYEVA, KATERINA YANA (NP)
Entity Type:Individual
Prefix:MS
First Name:KATERINA
Middle Name:YANA
Last Name:LEONTYEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 SOMERSET BLVD
Mailing Address - Street 2:APT 202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-872-3242
Mailing Address - Fax:
Practice Address - Street 1:1980 SOMERSET BLVD
Practice Address - Street 2:202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3935
Practice Address - Country:US
Practice Address - Phone:248-872-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229567163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse