Provider Demographics
NPI:1558980573
Name:LEYDEN, STEFANIE (APRN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:LEYDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 37TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-316-3250
Mailing Address - Fax:402-316-3264
Practice Address - Street 1:110 N 37TH ST STE 103
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3283
Practice Address - Country:US
Practice Address - Phone:402-316-3250
Practice Address - Fax:402-316-3264
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner