Provider Demographics
NPI:1811024672
Name:SECKINGER, LEANNE RENE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:RENE
Last Name:SECKINGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:LEANNE
Other - Middle Name:RENE
Other - Last Name:SECKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:615 CHERRY CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WANSHIP
Mailing Address - State:UT
Mailing Address - Zip Code:84017-9709
Mailing Address - Country:US
Mailing Address - Phone:435-336-6010
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4792517-4201282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital