MEDICARE: PAULA M LEIF CRNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	79092	NC

General Provider Information

NPI Number	:	1912996323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA M LEIF CRNP

Provider Business Mailing Address
First Line	:	511 RUIN CREEK RD
Second Line	:	SUITE 103
City	:	HENDERSON
State	:	NC
Zip	:	27536-5919
Country	:	US
Telephone Number	:	252-430-7700
Fax Number	:	252-430-8612

Provider Business Practice Location Address
First Line	:	511 RUIN CREEK RD
Second Line	:	SUITE 103
City	:	HENDERSON
State	:	NC
Zip	:	27536-5919
Country	:	US
Telephone Number	:	252-430-7700
Fax Number	:	252-430-8612

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/09/2007

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