Provider Demographics
NPI:1255390365
Name:LEIKNESS, JUDY ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:LEIKNESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6031 STAR SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9360
Mailing Address - Country:US
Mailing Address - Phone:920-568-1908
Mailing Address - Fax:920-563-5234
Practice Address - Street 1:W6031 STAR SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-9360
Practice Address - Country:US
Practice Address - Phone:920-568-1908
Practice Address - Fax:920-563-5234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17845-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse