Healthcare Provider Details

I. General information

NPI: 1487395497
Provider Name (Legal Business Name): LEONETTA JULES I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 MERCHANT LN STE 115
HAMPTON VA
23666-2696
US

IV. Provider business mailing address

221 LOCH CIR
HAMPTON VA
23669-5528
US

V. Phone/Fax

Practice location:
  • Phone: 757-656-0088
  • Fax:
Mailing address:
  • Phone: 757-656-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number834307717
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: