Provider Demographics
NPI:1255897500
Name:KINGRY, LEEANN
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:KINGRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-3206
Mailing Address - Country:US
Mailing Address - Phone:402-727-3050
Mailing Address - Fax:402-727-3033
Practice Address - Street 1:1750 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3206
Practice Address - Country:US
Practice Address - Phone:402-727-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57741163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool