Provider Demographics
NPI:1588838841
Name:MISHRA, LEENU (MD)
Entity Type:Individual
Prefix:
First Name:LEENU
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7222
Mailing Address - Country:US
Mailing Address - Phone:515-422-8067
Mailing Address - Fax:
Practice Address - Street 1:700 EAST UNIVERSITY AVE 3 WEST
Practice Address - Street 2:BLANK CHILDRENS PSYCHIATRY
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316
Practice Address - Country:US
Practice Address - Phone:515-263-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA384262084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA543960002Medicare PIN