Provider Demographics
NPI:1669555199
Name:HITZ, LEONARD JAMES (MSN/BC-FNP/APN)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:JAMES
Last Name:HITZ
Suffix:
Gender:M
Credentials:MSN/BC-FNP/APN
Other - Prefix:MR
Other - First Name:LEONARD
Other - Middle Name:JAMES
Other - Last Name:HITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1200 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2112
Mailing Address - Country:US
Mailing Address - Phone:815-490-1600
Mailing Address - Fax:815-490-1485
Practice Address - Street 1:1200 W STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-2112
Practice Address - Country:US
Practice Address - Phone:815-490-1600
Practice Address - Fax:815-490-1485
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008893363LF0000X
WAAP30007054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily