Healthcare Provider Details

I. General information

NPI: 1225305667
Provider Name (Legal Business Name): LEAH GEESTON-ENUM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH GEESTON

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S REYNOLDS ST APT 208
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

240 S REYNOLDS ST APT 208
ALEXANDRIA VA
22304-4460
US

V. Phone/Fax

Practice location:
  • Phone: 703-980-3810
  • Fax: 703-566-2075
Mailing address:
  • Phone: 703-980-3810
  • Fax: 703-566-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001187067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: