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General NPI Number Information
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NPI Number | 1942825872
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Entity Type | Individual
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Provider Name | LARITA LEAKE AS. NURSING
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 10404 VINEYARD BLVD STE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-3739
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Country | US
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Telephone | 405-463-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 9614 NE 4TH ST
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City | MIDWEST CITY
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State | OK
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Zip | 73130-2514
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Country | US
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Telephone | 405-906-1033
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 70361
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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