Provider Demographics
NPI:1396144457
Name:LEAK, DONICE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DONICE
Middle Name:
Last Name:LEAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 12TH ST SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3722
Mailing Address - Country:US
Mailing Address - Phone:202-715-7900
Mailing Address - Fax:
Practice Address - Street 1:3924 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2661
Practice Address - Country:US
Practice Address - Phone:202-398-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204968163W00000X
DCRN1008783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024905300Medicaid
DC024905300Medicaid