Provider Demographics
NPI:1942208491
Name:LEUENBERG, KARLA (ARNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:LEUENBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1359
Mailing Address - Country:US
Mailing Address - Phone:785-842-4477
Mailing Address - Fax:785-842-3473
Practice Address - Street 1:346 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1359
Practice Address - Country:US
Practice Address - Phone:785-842-4477
Practice Address - Fax:785-842-3473
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44826363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100450260AMedicaid