Provider Demographics
NPI:1992594683
Name:LEAVITT-JUDWARE, DEANNA JANICE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:JANICE
Last Name:LEAVITT-JUDWARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-9726
Mailing Address - Country:US
Mailing Address - Phone:716-201-8414
Mailing Address - Fax:
Practice Address - Street 1:3893 W LAKE RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9726
Practice Address - Country:US
Practice Address - Phone:716-201-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352820164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse