Provider Demographics
NPI:1356820161
Name:VOTSMIER, LEETA ANN
Entity Type:Individual
Prefix:
First Name:LEETA
Middle Name:ANN
Last Name:VOTSMIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N LINE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7543
Mailing Address - Country:US
Mailing Address - Phone:563-568-9154
Mailing Address - Fax:
Practice Address - Street 1:235 8TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1062
Practice Address - Country:US
Practice Address - Phone:563-547-6666
Practice Address - Fax:563-547-6393
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist