Provider Demographics
NPI:1699582759
Name:DE LEON, AUDRIANNA DARLENE (RN)
Entity type:Individual
Prefix:
First Name:AUDRIANNA
Middle Name:DARLENE
Last Name:DE LEON
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 1:4160 TAHOE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-8823
Mailing Address - Country:US
Mailing Address - Phone:812-841-0720
Mailing Address - Fax:
Practice Address - Street 1:4160 TAHOE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-8823
Practice Address - Country:US
Practice Address - Phone:812-841-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28259855A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse