Healthcare Provider Details

I. General information

NPI: 1386068807
Provider Name (Legal Business Name): ELIZABETH LEACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CAMP ST STE 1
HYANNIS MA
02601-3048
US

IV. Provider business mailing address

68 CAMP ST STE 1
HYANNIS MA
02601-3048
US

V. Phone/Fax

Practice location:
  • Phone: 774-470-1370
  • Fax:
Mailing address:
  • Phone: 774-487-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2286817
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08180453
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: