Provider Demographics
NPI:1992578157
Name:GAZDOVICH, LEENA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:GAZDOVICH
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N FOREST RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1200
Mailing Address - Country:US
Mailing Address - Phone:716-725-6370
Mailing Address - Fax:
Practice Address - Street 1:1360 N FOREST RD STE 111
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-1200
Practice Address - Country:US
Practice Address - Phone:716-725-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-303803163WL0100X
NY751326-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant