Provider Demographics
NPI:1356977813
Name:LEEPER, COURTNIE (RN, MSN, IBCLC)
Entity type:Individual
Prefix:
First Name:COURTNIE
Middle Name:
Last Name:LEEPER
Suffix:
Gender:F
Credentials:RN, MSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 MENLO COURT EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4717
Mailing Address - Country:US
Mailing Address - Phone:317-752-4542
Mailing Address - Fax:
Practice Address - Street 1:8137 MENLO COURT EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4717
Practice Address - Country:US
Practice Address - Phone:317-752-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28197035A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty