Provider Demographics
NPI:1588928469
Name:SULLIVAN, LEANE VERONICA (IBCLC)
Entity type:Individual
Prefix:
First Name:LEANE
Middle Name:VERONICA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24236A HWY 49 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24236A HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:NC
Practice Address - Zip Code:28137
Practice Address - Country:US
Practice Address - Phone:704-787-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN