Provider Demographics
NPI:1831167436
Name:PATTERSON, LEEANN K (DNP)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:K
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7980 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4170
Practice Address - Country:US
Practice Address - Phone:260-478-5220
Practice Address - Fax:260-458-3539
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001386A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200399620Medicaid
INM400032783Medicare PIN
IN71001386BOtherAPN CSR
IN200399620Medicaid
IN925510XMedicare PIN
INM400032783Medicare PIN
MP0849832OtherDEA
INMP0849832OtherDRUG ENFORCEMENT ADMIN