Individual
NANCY A LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2320 N LAKE DR, ROOM E2635, MILWAUKEE, WI 53211-4507
(414) 270-4812
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 270-4812
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2005
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43966800
—
WI
Enumeration date
01/30/2007
Last updated
11/15/2011
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