Healthcare Provider Details

I. General information

NPI: 1154326809
Provider Name (Legal Business Name): ANN L LEAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2005
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 PURCHASE ST
NEW BEDFORD MA
02740-6232
US

IV. Provider business mailing address

874 PURCHASE ST
NEW BEDFORD MA
02740-6232
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-6553
  • Fax: 508-990-7558
Mailing address:
  • Phone: 508-992-6553
  • Fax: 508-990-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number123505
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: