Provider Demographics
NPI:1063951978
Name:TOLIVER, LEANN MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MICHELLE
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:MICHELLE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2455 INTELLIPLEX DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8535
Mailing Address - Country:US
Mailing Address - Phone:317-392-3211
Mailing Address - Fax:
Practice Address - Street 1:2455 INTELLIPLEX DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8535
Practice Address - Country:US
Practice Address - Phone:317-392-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006864A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily