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NPI Code Detail

MEDICARE: MRS. LESHAUN ANGMOR F.N.P

MEDICARE: MRS. LESHAUN ANGMOR F.N.P
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF340500-1NY

General Provider Information

NPI Number : 1063874550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESHAUN ANGMOR F.N.P
Provider Business Mailing Address
First Line : 2 MOUNTAIN VIEW TER
Second Line : APT 7
City : LATHAM
State : NY
Zip : 12110-2049
Country : US
Telephone Number : 518-491-6601
Fax Number :
Provider Business Practice Location Address
First Line : 315 2ND AVE
Second Line : SUITE 2
City : TROY
State : NY
Zip : 12182-3237
Country : US
Telephone Number : 518-235-8034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2016
Last Update Date : 03/23/2016

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