Provider Demographics
NPI:1356086375
Name:TANIS, LEONNE (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEONNE
Middle Name:
Last Name:TANIS
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3810
Mailing Address - Country:US
Mailing Address - Phone:718-594-0366
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-342-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1059184363LW0102X
MDR252825367A00000X
DCCNM1059184367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR252825OtherMARYLAND BOARD OF NURSING
DCCNM1059184OtherDISTRICT OF COLUMBIA DEPARTMENT OF HEALTH
DCNP1059184OtherDISTRICT OF COLUMBIA DEPARTMENT OF HEALTH