Provider Demographics
NPI:1902247414
Name:PERRY, LEENA (LPN)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 E 90TH ST
Mailing Address - Street 2:APT#1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4853
Mailing Address - Country:US
Mailing Address - Phone:216-832-3771
Mailing Address - Fax:
Practice Address - Street 1:1832 E 90TH ST
Practice Address - Street 2:APT#1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4853
Practice Address - Country:US
Practice Address - Phone:216-832-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-145-306 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse