Provider Demographics
NPI:1922103431
Name:LEETE, STARLA R (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:R
Last Name:LEETE
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-352-8383
Mailing Address - Fax:307-352-8477
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5863
Practice Address - Country:US
Practice Address - Phone:307-352-8383
Practice Address - Fax:307-352-8477
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY274367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119171300Medicaid
WY119171300Medicaid
WY9955Medicare ID - Type Unspecified