Provider Demographics
NPI:1508219270
Name:LEONHARDT, REBECCA (CRNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4231 STATE ROUTE 370
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-8724
Mailing Address - Country:US
Mailing Address - Phone:937-726-3751
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD # 5
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-293-8228
Practice Address - Fax:937-293-8229
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.019524367500000X
TNRN0000213775163W00000X
FLRN9365357163W00000X
FLARNP9365357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse