Provider Demographics
NPI:1386376275
Name:LEONARD, SUSAN LEE (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-0288
Mailing Address - Country:US
Mailing Address - Phone:304-822-2177
Mailing Address - Fax:
Practice Address - Street 1:25072 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-5039
Practice Address - Country:US
Practice Address - Phone:304-822-2177
Practice Address - Fax:304-822-4977
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse