Provider Demographics
NPI:1265211924
Name:CONCORDIA, LEANNE N (CRNP)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:N
Last Name:CONCORDIA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 THORNHILL RD APT 71B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-4045
Mailing Address - Country:US
Mailing Address - Phone:608-577-2412
Mailing Address - Fax:
Practice Address - Street 1:500 22ND ST S FL 3
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3110
Practice Address - Country:US
Practice Address - Phone:205-975-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily