Healthcare Provider Details

I. General information

NPI: 1427939578
Provider Name (Legal Business Name): MIYA MARIE LEONARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10019 S 9TH CIR
BELLEVUE NE
68123-4023
US

IV. Provider business mailing address

10019 S 9TH CIR
BELLEVUE NE
68123-4023
US

V. Phone/Fax

Practice location:
  • Phone: 402-850-5466
  • Fax:
Mailing address:
  • Phone: 402-850-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14582
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: