Provider Demographics
NPI:1710322276
Name:DEL GAUDIO, LEAH MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:DEL GAUDIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:BELTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2900 WEST OKLAHOMA AVE.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-649-6472
Mailing Address - Fax:
Practice Address - Street 1:2900 WEST OKLAHOMA AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-649-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5302363L00000X
WI5302-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner