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General NPI Number Information
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NPI Number | 1548280381
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Entity Type | Individual
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Provider Name | CONSTANCE LEE BALLEM LEACH CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 850 N 11TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1957
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Country | US
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Telephone | 215-769-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 135 E LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-1011
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Country | US
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Telephone | 215-425-5400
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Fax | 215-425-0918
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP007552
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License Number State | PA
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