Individual
MRS. JULIENNE ELAINE LEYVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
921 W BAROUCHE, PENDLETON, IN 46064-8699
(765) 221-9106
Mailing address
921 W BAROUCHE, PENDLETON, IN 46064-8699
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71002421A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01198026
RR MEDICARE PTAN
IN
Enumeration date
06/09/2008
Last updated
06/04/2015
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