MEDICARE: LEA DOBLE RN

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	163W00000X	Registered Nurse	668665-1	NY

General Provider Information

NPI Number	:	1215705546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA DOBLE RN

Provider Business Mailing Address
First Line	:	12243 NELLIS ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-1030
Country	:	US
Telephone Number	:	904-631-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	12243 NELLIS ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-1030
Country	:	US
Telephone Number	:	904-631-8857
Fax Number	:

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

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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