=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154326809
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN L LEAL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2005
-----------------------------------------------------
Last Update Date | 01/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 874 PURCHASE ST
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-992-6553
-----------------------------------------------------
Fax | 508-990-7558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 874 PURCHASE ST
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-992-6553
-----------------------------------------------------
Fax | 508-990-7558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 123505
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------