Provider Demographics
NPI:1700928850
Name:TILDEN, LEANN (RN,BSN,CDE)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:TILDEN
Suffix:
Gender:F
Credentials:RN,BSN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 GENEVA RD APT 7
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3667
Mailing Address - Country:US
Mailing Address - Phone:920-475-6074
Mailing Address - Fax:
Practice Address - Street 1:1818 N. MEADE ST.
Practice Address - Street 2:APPLETON MEDICAL CENTER
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-729-3110
Practice Address - Fax:920-831-5093
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI79510-030163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator