Provider Demographics
NPI:1528556503
Name:WILTISON, LEIGH ANN (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:LEIGH
Middle Name:ANN
Last Name:WILTISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15113 TRAIL RIDGE RD SW # 11513
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5846
Mailing Address - Country:US
Mailing Address - Phone:301-876-1348
Mailing Address - Fax:
Practice Address - Street 1:251 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1375
Practice Address - Country:US
Practice Address - Phone:301-533-4000
Practice Address - Fax:301-895-8752
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily