Provider Demographics
NPI:1093411316
Name:LEONE, AUDREY MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:MARIE
Last Name:LEONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9334
Mailing Address - Country:US
Mailing Address - Phone:585-789-7762
Mailing Address - Fax:
Practice Address - Street 1:12 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9334
Practice Address - Country:US
Practice Address - Phone:585-789-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346365164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse