Provider Demographics
NPI:1679807911
Name:LEUENBERGER-BANKS, LAURA A (FNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:LEUENBERGER-BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:LEUENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4850 SMITH RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2797
Mailing Address - Country:US
Mailing Address - Phone:513-841-0777
Mailing Address - Fax:513-841-0877
Practice Address - Street 1:4850 SMITH RD STE 100A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2797
Practice Address - Country:US
Practice Address - Phone:513-841-0777
Practice Address - Fax:513-841-0877
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN319869363LF0000X
OHCOA10945NP363LF0000X
OHRX10945EX1363LF0000X
OHCOA101945NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3010735Medicaid
OH3010735Medicaid