Provider Demographics
NPI:1053640631
Name:WILCINSKI, SUSAN LEINBACH (NNP-BC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEINBACH
Last Name:WILCINSKI
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1235
Mailing Address - Country:US
Mailing Address - Phone:303-469-2987
Mailing Address - Fax:
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:303-469-2987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO63006363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal