Healthcare Provider Details

I. General information

NPI: 1982309431
Provider Name (Legal Business Name): LEAH MARIE ALLEN CDP, CMDCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LEAH MARIE LYONS

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 JANIS DR
OSCODA MI
48750-9277
US

IV. Provider business mailing address

5658 JANIS DR
OSCODA MI
48750-9277
US

V. Phone/Fax

Practice location:
  • Phone: 989-916-3082
  • Fax:
Mailing address:
  • Phone: 989-916-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: