Provider Demographics
NPI:1790662138
Name:NEU, LEANNE CEDARSTROM
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:CEDARSTROM
Last Name:NEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:LIND
Other - Last Name:CEDARSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 TALL RUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5243
Mailing Address - Country:US
Mailing Address - Phone:480-678-4054
Mailing Address - Fax:
Practice Address - Street 1:5660 W FLAMINGO RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2312
Practice Address - Country:US
Practice Address - Phone:702-890-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV890157363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty