MEDICARE: MS. TAMMY SUE LEAK 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
1	164W00000X	Licensed Practical Nurse	PN102252	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457510570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY SUE LEAK LPN

Provider Business Mailing Address
First Line	:	439 HARRISON AVENUE
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-3403
Country	:	US
Telephone Number	:	513-894-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7390 ROLLING MEADOWS DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1286
Country	:	US
Telephone Number	:	513-755-0142
Fax Number	:

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

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	07/03/2008

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