Provider Demographics
NPI:1265761969
Name:ANTHON, LEANNE (RN)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:ANTHON
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 1:603 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1021
Mailing Address - Country:US
Mailing Address - Phone:920-988-4027
Mailing Address - Fax:
Practice Address - Street 1:603 FREMONT ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1021
Practice Address - Country:US
Practice Address - Phone:920-988-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169057-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse