MEDICARE: DALLAS LEONARD ANP

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
1	363L00000X	Nurse Practitioner	212247	MA

General Provider Information

NPI Number	:	1316949407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS LEONARD ANP

Provider Business Mailing Address
First Line	:	39 FAUNCE CORNER RD
Second Line	:
City	:	N DARTMOUTH
State	:	MA
Zip	:	02747-4202
Country	:	US
Telephone Number	:	508-996-3311
Fax Number	:	508-996-3674

Provider Business Practice Location Address
First Line	:	39 FAUNCE CORNER RD
Second Line	:
City	:	N DARTMOUTH
State	:	MA
Zip	:	02747-4202
Country	:	US
Telephone Number	:	508-996-3311
Fax Number	:	508-996-3674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	01/04/2011

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Directions to “ DALLAS LEONARD ANP” Practice Location

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