Provider Demographics
NPI:1912177379
Name:LEITNER, DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:LEITNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:CARDIOTHORACIC SURGERY DEPARTMENT
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1652
Mailing Address - Country:US
Mailing Address - Phone:914-493-8793
Mailing Address - Fax:
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:CARDIOTHORACIC SURGERY DEPARTMENT
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1652
Practice Address - Country:US
Practice Address - Phone:914-493-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302639363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health