MEDICARE: MRS. JANET R. LEATHEM PMHNP-BC

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	ARNP 9313958	FL

General Provider Information

NPI Number	:	1982705018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET R. LEATHEM PMHNP-BC

Provider Business Mailing Address
First Line	:	5749 CAMINO DEL SOL
Second Line	:	SUITE 206
City	:	BOCA RATON
State	:	FL
Zip	:	33433-6564
Country	:	US
Telephone Number	:	954-800-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	5749 CAMINO DEL SOL
Second Line	:	SUITE 206
City	:	BOCA RATON
State	:	FL
Zip	:	33433-6564
Country	:	US
Telephone Number	:	954-800-0234
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/01/2013

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