Provider Demographics
NPI:1619103801
Name:LEESER, TAMMY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:LEESER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ROSALYN ST
Mailing Address - Street 2:
Mailing Address - City:DICKEYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53808-6860
Mailing Address - Country:US
Mailing Address - Phone:608-568-3190
Mailing Address - Fax:
Practice Address - Street 1:150 ROSALYN ST
Practice Address - Street 2:
Practice Address - City:DICKEYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53808-6860
Practice Address - Country:US
Practice Address - Phone:608-568-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148954030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse