Healthcare Provider Details

I. General information

NPI: 1699638791
Provider Name (Legal Business Name): LEAH LYNN VEGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

IV. Provider business mailing address

1613A CEDAR ST
JOINT BASE MDL NJ
08640-1618
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-9443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95254678
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR26971900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number26NR26971900
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NR26971900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: