MEDICARE: ANNIKA KATHERINE LEYDON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1952839490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIKA KATHERINE LEYDON

Provider Business Mailing Address
First Line	:	PO BOX 639
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-0639
Country	:	US
Telephone Number	:	508-685-9506
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 HIGH ST
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-2604
Country	:	US
Telephone Number	:	508-685-9506
Fax Number	:

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

Provider Enumeration Date	:	05/29/2017
Last Update Date	:	07/21/2022

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Directions to “ ANNIKA KATHERINE LEYDON ” Practice Location

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