Provider Demographics
NPI:1083029128
Name:STANTON, LEATRICE
Entity Type:Individual
Prefix:MS
First Name:LEATRICE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1704
Mailing Address - Country:US
Mailing Address - Phone:989-907-7574
Mailing Address - Fax:989-907-7702
Practice Address - Street 1:723 EMERSON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1704
Practice Address - Country:US
Practice Address - Phone:989-907-7574
Practice Address - Fax:989-907-7702
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker