Provider Demographics
NPI:1003476102
Name:LEEDLE, JELKA (APNP)
Entity type:Individual
Prefix:
First Name:JELKA
Middle Name:
Last Name:LEEDLE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N891 STATE ROAD 120
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4224
Mailing Address - Country:US
Mailing Address - Phone:608-322-6564
Mailing Address - Fax:
Practice Address - Street 1:N891 STATE ROAD 120
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4224
Practice Address - Country:US
Practice Address - Phone:608-322-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10681-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology