Provider Demographics
NPI:1427184936
Name:HART, ANN LEICHTLE (PMP-NP,CNS, BC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LEICHTLE
Last Name:HART
Suffix:
Gender:F
Credentials:PMP-NP,CNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1255
Mailing Address - Country:US
Mailing Address - Phone:919-833-5869
Mailing Address - Fax:919-833-5859
Practice Address - Street 1:867 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1255
Practice Address - Country:US
Practice Address - Phone:919-833-5869
Practice Address - Fax:919-833-5859
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2599019Medicare ID - Type Unspecified