=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831439017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNY LEONIDAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2013
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 COVE RD APT A4
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-286-8192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 COVE RD APT A4
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-286-8192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 313100-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------