Provider Demographics
NPI:1699119164
Name:PERSONETT, LEANN MARIE (RN)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MARIE
Last Name:PERSONETT
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 1:334 N AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-8684
Mailing Address - Country:US
Mailing Address - Phone:608-371-7335
Mailing Address - Fax:
Practice Address - Street 1:334 N AUSTIN RD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-8684
Practice Address - Country:US
Practice Address - Phone:608-371-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173908-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse