Provider Demographics
NPI:1558674465
Name:WEINERT-WATSON, LEANNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:ELIZABETH
Last Name:WEINERT-WATSON
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 1:1301 TRUMANSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2365
Mailing Address - Fax:607-277-1415
Practice Address - Street 1:201 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1345
Practice Address - Country:US
Practice Address - Phone:607-277-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily