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NPI Code Detail

MEDICARE: MRS. LEESA HERRMANN LPN

MEDICARE:  MRS. LEESA  HERRMANN  LPN
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
1164W00000XLicensed Practical NurseL0020159OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L0020159OTHEROKOKLAHOMA BOARD OF NURSING

General Provider Information

NPI Number : 1205938966
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEESA HERRMANN LPN
Provider Business Mailing Address
First Line : 312 W 2ND ST
Second Line :
City : CHANDLER
State : OK
Zip : 74834-2065
Country : US
Telephone Number : 405-258-5439
Fax Number :
Provider Business Practice Location Address
First Line : 112 MCKINLEY AVE
Second Line :
City : CHANDLER
State : OK
Zip : 74834-1622
Country : US
Telephone Number : 405-258-3040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LEESA HERRMANN LPN” Practice Location

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