Provider Demographics
NPI:1801077763
Name:PAGLIA, LEISANN MARIE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LEISANN
Middle Name:MARIE
Last Name:PAGLIA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LEISANN
Other - Middle Name:MARIE
Other - Last Name:STOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:214 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3748
Mailing Address - Country:US
Mailing Address - Phone:307-633-7981
Mailing Address - Fax:307-432-3127
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-633-7981
Practice Address - Fax:307-432-3127
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
809068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered