Healthcare Provider Details

I. General information

NPI: 1932423720
Provider Name (Legal Business Name): LEENA JOSEPH I CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEENA GEORGE CRNP

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 HUNTINGDON PIKE
MEADOWBROOK PA
19046-8001
US

IV. Provider business mailing address

12265 TOWNSEND RD
PHILADELPHIA PA
19154-1201
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-2749
  • Fax: 215-938-3829
Mailing address:
  • Phone: 215-856-1010
  • Fax: 215-698-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP010046
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN558835
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: