Provider Demographics
NPI:1396964912
Name:LEITAO, LAUREEN PATRICIA (RN)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:PATRICIA
Last Name:LEITAO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAUREEN
Other - Middle Name:PATRICIA
Other - Last Name:CORRIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1904 ARUNDEL RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3409
Mailing Address - Country:US
Mailing Address - Phone:410-437-9325
Mailing Address - Fax:
Practice Address - Street 1:1720 POPLAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3743
Practice Address - Country:US
Practice Address - Phone:410-222-6450
Practice Address - Fax:410-222-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167450163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool