Provider Demographics
NPI:1962748566
Name:LEACHMAN-RUSS, ROSE-MARIE L (RN)
Entity type:Individual
Prefix:
First Name:ROSE-MARIE
Middle Name:L
Last Name:LEACHMAN-RUSS
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 1:5420 POST RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2607
Mailing Address - Country:US
Mailing Address - Phone:347-834-3164
Mailing Address - Fax:
Practice Address - Street 1:5420 POST RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2607
Practice Address - Country:US
Practice Address - Phone:347-834-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse