MEDICARE: ANTIONE L LEONARD SR.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1720550510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTIONE L LEONARD SR.

Provider Business Mailing Address
First Line	:	6243 HOPEFUL LIGHT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6866
Country	:	US
Telephone Number	:	773-678-4733
Fax Number	:

Provider Business Practice Location Address
First Line	:	5446 BOULDER HWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6069
Country	:	US
Telephone Number	:	702-291-7121
Fax Number	:

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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