Healthcare Provider Details

I. General information

NPI: 1922962513
Provider Name (Legal Business Name): LEIGHANN EBENEZER DNP FNP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGHANN OLDHAM

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 CHEVERLY AVE
CHEVERLY MD
20785-3016
US

IV. Provider business mailing address

2718 CHEVERLY AVE
CHEVERLY MD
20785-3016
US

V. Phone/Fax

Practice location:
  • Phone: 585-750-9638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR202314
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: