Provider Demographics
NPI:1386725653
Name:LEINEN, CARLA JILL (FNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JILL
Last Name:LEINEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E LYONS ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2132
Mailing Address - Country:US
Mailing Address - Phone:307-745-0085
Mailing Address - Fax:307-745-0084
Practice Address - Street 1:504 E LYONS ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2132
Practice Address - Country:US
Practice Address - Phone:307-745-0085
Practice Address - Fax:307-745-0084
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16074.262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70089Medicare UPIN
9705Medicare ID - Type Unspecified