Provider Demographics
NPI:1194505925
Name:LEESEBERG, KRISTINA A (RN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:LEESEBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:A
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3074 E M 72
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48740-9714
Mailing Address - Country:US
Mailing Address - Phone:989-255-6961
Mailing Address - Fax:
Practice Address - Street 1:318 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2306
Practice Address - Country:US
Practice Address - Phone:989-358-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301408163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management