Provider Demographics
NPI:1437266525
Name:VITEK, LEESA ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:ANN
Last Name:VITEK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-6902
Mailing Address - Country:US
Mailing Address - Phone:717-701-8251
Mailing Address - Fax:717-701-8289
Practice Address - Street 1:19 SPRINT DR STE 1
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7002
Practice Address - Country:US
Practice Address - Phone:717-701-8251
Practice Address - Fax:717-701-8289
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ74186Medicare UPIN