Provider Demographics
NPI:1942811195
Name:LEIDING, WENDY SUE (LPN, RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:LEIDING
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5110
Mailing Address - Country:US
Mailing Address - Phone:308-385-5900
Mailing Address - Fax:
Practice Address - Street 1:123 S WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5110
Practice Address - Country:US
Practice Address - Phone:308-385-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse