Provider Demographics
NPI:1912495714
Name:LEITSCHUH, ANDREA RENEE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RENEE
Last Name:LEITSCHUH
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 1:5021 LINCREST PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2738
Mailing Address - Country:US
Mailing Address - Phone:934-604-9338
Mailing Address - Fax:
Practice Address - Street 1:100 ELMWOOD PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5402
Practice Address - Country:US
Practice Address - Phone:934-384-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.369681163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse