Provider Demographics
NPI:1720562853
Name:DITTRICH, LEANN (FNP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-6314
Mailing Address - Country:US
Mailing Address - Phone:914-248-0500
Mailing Address - Fax:914-444-4248
Practice Address - Street 1:157 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6314
Practice Address - Country:US
Practice Address - Phone:914-248-0500
Practice Address - Fax:914-444-4248
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily