MEDICARE: RENEE NICOLE LEARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R199634	MD

General Provider Information

NPI Number	:	1114730538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE NICOLE LEARY

Provider Business Mailing Address
First Line	:	13115 DULANEY VALLEY RD
Second Line	:
City	:	GLEN ARM
State	:	MD
Zip	:	21057-9601
Country	:	US
Telephone Number	:	443-414-5815
Fax Number	:

Provider Business Practice Location Address
First Line	:	13115 DULANEY VALLEY RD
Second Line	:
City	:	GLEN ARM
State	:	MD
Zip	:	21057-9601
Country	:	US
Telephone Number	:	443-414-5815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	05/12/2026

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