Provider Demographics
NPI:1073145413
Name:LEITER, MADELINE ROSE (MS, PHARMD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:LEITER
Suffix:
Gender:
Credentials:MS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S 38TH STREET CT APT 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3576
Mailing Address - Country:US
Mailing Address - Phone:402-770-0750
Mailing Address - Fax:
Practice Address - Street 1:4435 O ST STE 211
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1864
Practice Address - Country:US
Practice Address - Phone:402-489-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NE16560183500000X
NE14327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No183500000XPharmacy Service ProvidersPharmacist