Provider Demographics
NPI:1033633631
Name:DETERRA, LEANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:DETERRA
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 1:37 FRIEND STREET
Mailing Address - Street 2:ELEMENT CARE INC
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-715-6608
Mailing Address - Fax:781-715-6699
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:ELEMENT CARE SUITE 166D
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-712-3360
Practice Address - Fax:978-712-3392
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA270339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse