Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP011982 | PA |
NPI | 1003189093 |
---|---|
Provider Name | Jennifer Leonida |
First Address | Mt Pleasant, PA 15666-1458 |
Second Address | Mt Pleasant, PA 15666-1458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 22/02/2012 |