Provider Demographics
NPI:1578520383
Name:LEIS, JOYCE ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELAINE
Last Name:LEIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JOYCE
Other - Middle Name:ELAINE
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1360
Mailing Address - Country:US
Mailing Address - Phone:608-375-4229
Mailing Address - Fax:
Practice Address - Street 1:704 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1360
Practice Address - Country:US
Practice Address - Phone:608-375-4229
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38323600OtherPN