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General NPI Number Information
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NPI Number | 1801407176
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Entity Type | Individual
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Provider Name | KAITLYN LEASURE
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 161 HUNTER DR
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-7605
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Country | US
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Telephone | 878-208-4322
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Fax |
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Provider Business Mailing Address
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Address Line | 783 W OLD ROUTE 422
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City | BUTLER
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State | PA
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Zip | 16001-0247
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Country | US
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Telephone | 724-709-5098
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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