Provider Demographics
NPI:1609193820
Name:TATNALL, LEIGH ANN (RN CHPN)
Entity Type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:
Last Name:TATNALL
Suffix:
Gender:F
Credentials:RN CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2720
Mailing Address - Country:US
Mailing Address - Phone:414-255-7398
Mailing Address - Fax:
Practice Address - Street 1:7410 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2720
Practice Address - Country:US
Practice Address - Phone:414-255-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158289-30390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program