Provider Demographics
NPI:1104106467
Name:LEIDEL, ANNE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:LEIDEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27343 LEMAYS CT
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1986
Mailing Address - Country:US
Mailing Address - Phone:414-801-1096
Mailing Address - Fax:
Practice Address - Street 1:27343 LEMAYS CT
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-1986
Practice Address - Country:US
Practice Address - Phone:414-801-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94730-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health