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General NPI Number Information
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NPI Number | 1740169424
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Entity Type | Individual
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Provider Name | LEISA DWAMENA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 309 BELMONT ST
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City | WORCESTER
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State | MA
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Zip | 01604-1059
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Country | US
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Telephone | 508-368-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 31 ONSET ST
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City | WORCESTER
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State | MA
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Zip | 01604-2013
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Country | US
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Telephone | 603-674-6969
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Fax | 603-674-6969
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2296460
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License Number State | MH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2296460
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License Number State | MA
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