Provider Demographics
NPI:1831333095
Name:FOUGH, LEONIE D (RN)
Entity type:Individual
Prefix:MRS
First Name:LEONIE
Middle Name:D
Last Name:FOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6220
Mailing Address - Country:US
Mailing Address - Phone:212-491-3205
Mailing Address - Fax:212-491-3205
Practice Address - Street 1:198 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3627
Practice Address - Country:US
Practice Address - Phone:718-290-2410
Practice Address - Fax:718-856-6867
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse