Provider Demographics
NPI:1588952709
Name:CRUZ-PEREZ, LEIA (RN)
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:CRUZ-PEREZ
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 1:1725 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3819
Mailing Address - Country:US
Mailing Address - Phone:715-498-0305
Mailing Address - Fax:
Practice Address - Street 1:1725 FREMONT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3819
Practice Address - Country:US
Practice Address - Phone:715-498-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173988-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse