Individual provider Active NPI

Nancy A Leahy, NP

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1407992779
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2005 Issued in WI
Practice address
2320 N Lake Dr
Room E2635
Milwaukee, WI 53211-4507
Phone
(414) 270-4812
NPI assigned
Jan 30, 2007
Last updated
Nov 15, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2005 WI Primary

Addresses

Primary practice location

2320 N Lake Dr
Room E2635
Milwaukee, WI 53211-4507

Mailing address

4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 270-4812

Other identifiers 1

IdentifierTypeStateIssuer
43966800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050728000761 WI Practitioner - Nurse Practitioner 2860420197 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2005WIMDNurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1407992779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-270-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 N LAKE DR",
            "address_2": "ROOM E2635",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114507",
            "telephone_number": "414-270-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAHY",
        "first_name": "NANCY",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "2005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43966800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.