Provider Demographics
NPI:1053782508
Name:LEITERITZ, KATIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LEITERITZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8020 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2930
Mailing Address - Country:US
Mailing Address - Phone:414-647-3920
Mailing Address - Fax:
Practice Address - Street 1:8020 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2930
Practice Address - Country:US
Practice Address - Phone:414-647-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6537-33363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily