Healthcare Provider Details

I. General information

NPI: 1225219660
Provider Name (Legal Business Name): CONCEPCION LEAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 INDIANAPOLIS BLVD
EAST CHICAGO IN
46312-3227
US

IV. Provider business mailing address

4522 INDIANAPOLIS BLVD
EAST CHICAGO IN
46312-3227
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-4335
  • Fax: 219-397-4651
Mailing address:
  • Phone: 219-397-4335
  • Fax: 219-397-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number28126018A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: