Provider Demographics
NPI:1336970722
Name:CANTRELLE, LEAH G
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:G
Last Name:CANTRELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17657 W JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-7743
Mailing Address - Country:US
Mailing Address - Phone:228-297-2901
Mailing Address - Fax:
Practice Address - Street 1:17657 W JORDAN RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-7743
Practice Address - Country:US
Practice Address - Phone:228-297-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program