Provider Demographics
NPI:1154791408
Name:MANSKER, LEEANN (RN)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:MANSKER
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 1:6581 N BETHMAUR LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3363
Mailing Address - Country:US
Mailing Address - Phone:414-491-0881
Mailing Address - Fax:
Practice Address - Street 1:6581 N BETHMAUR LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3363
Practice Address - Country:US
Practice Address - Phone:414-491-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161372163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care