Provider Demographics
NPI:1609312008
Name:LEITHNER, CAROLINE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LEITHNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13595 E CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-3362
Mailing Address - Country:US
Mailing Address - Phone:918-698-2476
Mailing Address - Fax:
Practice Address - Street 1:1015 4TH AVE W STE H
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5492
Practice Address - Country:US
Practice Address - Phone:360-328-1982
Practice Address - Fax:844-831-8511
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205200363LP2300X
WAAP60702221363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily