Provider Demographics
NPI:1811101975
Name:BEHNY, LEANNE P (CRNA)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:P
Last Name:BEHNY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-8182
Mailing Address - Country:US
Mailing Address - Phone:574-583-7111
Mailing Address - Fax:574-583-1774
Practice Address - Street 1:720 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8182
Practice Address - Country:US
Practice Address - Phone:574-583-7111
Practice Address - Fax:574-583-1774
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28124069367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200518850Medicaid
INCC3020GMedicare UPIN