Organization
LEITHERLAND FAMILY CARE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDNA R LEITHERLAND FNP.C (OWNER)
(731) 692-2853
Entity
Organization
Contact information
Practice address
1123 N MAIN ST, DYER, TN 38330-1019
(731) 692-2853
(731) 692-2367
Mailing address
1123 N MAIN ST, DYER, TN 38330-1019
(731) 692-2853
(731) 692-2367
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
APN5603
TN
261QP2300X
Primary Care Clinic/Center
RN53289
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S66580
UPIN
TN
Enumeration date
02/22/2008
Last updated
03/24/2008
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