Provider Demographics
NPI:1548352875
Name:LEAHY, LAURA GROBLEWSKI (DRNP, APRN)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GROBLEWSKI
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DRNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EGG HARBOR RD
Mailing Address - Street 2:SUITE 703 TOWER COMMONS
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9406
Mailing Address - Country:US
Mailing Address - Phone:856-556-0860
Mailing Address - Fax:844-276-7656
Practice Address - Street 1:123 EGG HARBOR RD
Practice Address - Street 2:SUITE 703 TOWER COMMONS
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9406
Practice Address - Country:US
Practice Address - Phone:856-556-0860
Practice Address - Fax:844-276-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08502400163W00000X
NJ26NC08502400363LP0808X
PASP008666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6661009Medicaid
NJ692478Medicare ID - Type Unspecified
R99171Medicare UPIN