Provider Demographics
NPI:1144064189
Name:LEONHARDT, BRIANNA TAYLOR (LPN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:TAYLOR
Last Name:LEONHARDT
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 1:847 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2504
Mailing Address - Country:US
Mailing Address - Phone:315-484-8615
Mailing Address - Fax:
Practice Address - Street 1:847 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2504
Practice Address - Country:US
Practice Address - Phone:315-484-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331931-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse