Provider Demographics
NPI:1861109183
Name:DANIEL, LEEANN KAY (60220256041 STNA)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:KAY
Last Name:DANIEL
Suffix:
Gender:F
Credentials:60220256041 STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PERDUE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9620
Mailing Address - Country:US
Mailing Address - Phone:740-941-9857
Mailing Address - Fax:
Practice Address - Street 1:202 PERDUE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9620
Practice Address - Country:US
Practice Address - Phone:740-941-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6022025604213747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant