Provider Demographics
NPI:1104539485
Name:LEADER, JOANNE (AGNP-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LEADER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EAGLE NEST RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1062
Mailing Address - Country:US
Mailing Address - Phone:917-816-6649
Mailing Address - Fax:
Practice Address - Street 1:1 EAGLE NEST RD
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1062
Practice Address - Country:US
Practice Address - Phone:917-816-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01476400163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology