Provider Demographics
NPI:1780967075
Name:RYTEL, LEANNE M (PA-C)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:RYTEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:M
Other - Last Name:MANSBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:MC CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:30 HOPE DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-5638
Practice Address - Fax:717-531-0983
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1603431OtherGATEWAY MEDICARE ASSURED
PA2675542OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA348233Medicare PIN