Healthcare Provider Details

I. General information

NPI: 1992633382
Provider Name (Legal Business Name): LEEANNA J WALLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N 2ND ST APT A
HAMILTON OH
45011-1659
US

IV. Provider business mailing address

5480 SCHIERING DR
FAIRFIELD OH
45014-2444
US

V. Phone/Fax

Practice location:
  • Phone: 513-600-2272
  • Fax:
Mailing address:
  • Phone: 513-600-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN.480968
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.480968
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberRN.480968
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN.480968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: