Provider Demographics
NPI:1053703405
Name:HALL, LEADEANE VENESA (RN)
Entity type:Individual
Prefix:MISS
First Name:LEADEANE
Middle Name:VENESA
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4126 BRONXWOOD AVE
Mailing Address - Street 2:APT 2R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4524
Mailing Address - Country:US
Mailing Address - Phone:917-361-0591
Mailing Address - Fax:
Practice Address - Street 1:4126 BRONXWOOD AVE
Practice Address - Street 2:APT 2R
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4524
Practice Address - Country:US
Practice Address - Phone:917-361-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661463-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse