Healthcare Provider Details

I. General information

NPI: 1881334092
Provider Name (Legal Business Name): JAYNIE LYNN LEONARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 MAPLE SPRINGS ELLERY RD
BEMUS POINT NY
14712-9723
US

IV. Provider business mailing address

5113 MAPLE SPRINGS ELLERY RD
BEMUS POINT NY
14712-9723
US

V. Phone/Fax

Practice location:
  • Phone: 716-499-7113
  • Fax:
Mailing address:
  • Phone: 716-499-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7511778-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: