Basic Information
| Provider Information | |||||||||
| NPI: | 1962079343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEININGER | ||||||||
| FirstName: | GINELA | ||||||||
| MiddleName: | BOLIVAR | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 STUART ST | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365267522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516041109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 MOBILE INFIRMARY CIR STE G-805 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366073513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2021 | ||||||||
| LastUpdateDate: | 06/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-151798 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.