Individual
MS. CYNTHIA LOU LEICHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6620
(260) 672-6639
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002883A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000606784
ANTHEM
IN
05
—
200936010
—
IN
01
—
P00717115
MEDICARE RR
IN
Enumeration date
03/17/2009
Last updated
03/11/2021
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