Provider Demographics
NPI:1124464094
Name:LEISCHNER, DONNA MARIE (CERTIFIED NURSE PRAC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:LEISCHNER
Suffix:
Gender:F
Credentials:CERTIFIED NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-2093
Mailing Address - Country:US
Mailing Address - Phone:217-245-5111
Mailing Address - Fax:217-243-4773
Practice Address - Street 1:345 W STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2093
Practice Address - Country:US
Practice Address - Phone:217-245-5111
Practice Address - Fax:217-243-4773
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.001853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner