Provider Demographics
NPI:1679885123
Name:LEIS, ANNE E (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:E
Last Name:LEIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6-16 ROCKY MOUNTAIN DR N
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-8912
Mailing Address - Country:US
Mailing Address - Phone:570-620-1311
Mailing Address - Fax:570-620-1311
Practice Address - Street 1:6-16 ROCKY MOUNTAIN DR N
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-8912
Practice Address - Country:US
Practice Address - Phone:570-620-1311
Practice Address - Fax:570-620-1311
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA181398L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse