Healthcare Provider Details

I. General information

NPI: 1912721762
Provider Name (Legal Business Name): ROXCEENE CAROL LEANOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 GLENWOOD AVE
BUFFALO NY
14208-1916
US

IV. Provider business mailing address

504 GLENWOOD AVE
BUFFALO NY
14208-1916
US

V. Phone/Fax

Practice location:
  • Phone: 716-715-5250
  • Fax:
Mailing address:
  • Phone: 716-715-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number764977-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number764977-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: