Provider Demographics
NPI:1093452690
Name:DOUGLAS, LENESHIA RAINELLE (RN)
Entity Type:Individual
Prefix:
First Name:LENESHIA
Middle Name:RAINELLE
Last Name:DOUGLAS
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 1:13753 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2840
Mailing Address - Country:US
Mailing Address - Phone:929-732-9125
Mailing Address - Fax:
Practice Address - Street 1:13753 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2840
Practice Address - Country:US
Practice Address - Phone:929-732-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY807764-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse