Provider Demographics
NPI:1972016616
Name:PITTERLE, LEIGH A (RN)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:A
Last Name:PITTERLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 STUDENT HEALTH CTR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-2129
Mailing Address - Country:US
Mailing Address - Phone:814-863-9063
Mailing Address - Fax:
Practice Address - Street 1:351 STUDENT HEALTH CTR
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-2129
Practice Address - Country:US
Practice Address - Phone:814-863-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN298165L163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN298165LOtherRN