Healthcare Provider Details

I. General information

NPI: 1679030142
Provider Name (Legal Business Name): LEAH D WARD MSN, MA, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH D WARD MSN, MA, A-GNP-C

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEARL ST FL 14
HARTFORD CT
06103-4500
US

IV. Provider business mailing address

333 COMMERCE ST STE 700
NASHVILLE TN
37201-1835
US

V. Phone/Fax

Practice location:
  • Phone: 888-355-3902
  • Fax: 855-737-5542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberE61150
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8117
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: