Provider Demographics
NPI:1508677063
Name:LEINWEBER, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LEINWEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 POTASH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3955
Mailing Address - Country:US
Mailing Address - Phone:308-762-3709
Mailing Address - Fax:
Practice Address - Street 1:216 POTASH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3955
Practice Address - Country:US
Practice Address - Phone:308-762-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider