Provider Demographics
NPI:1487313029
Name:LEONE, LINDA (RN, CRRN, CCM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:RN, CRRN, CCM
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 87185
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0185
Mailing Address - Country:US
Mailing Address - Phone:734-634-7783
Mailing Address - Fax:734-207-5082
Practice Address - Street 1:6529 KINGS MILL DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5476
Practice Address - Country:US
Practice Address - Phone:734-634-7783
Practice Address - Fax:734-207-5086
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704125113171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator