Provider Demographics
NPI:1649262908
Name:LEANDRO, LYNN D (GNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:D
Last Name:LEANDRO
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:D
Other - Last Name:HEUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:1024B GARNER RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6600
Mailing Address - Country:US
Mailing Address - Phone:404-778-3732
Mailing Address - Fax:404-778-3643
Practice Address - Street 1:1024B GARNER RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6600
Practice Address - Country:US
Practice Address - Phone:404-778-3732
Practice Address - Fax:404-778-3643
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ21702Medicare UPIN