Provider Demographics
NPI:1093961674
Name:DUNLAP, LEIGH ANN (LPTA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 CLEAR SKY PATH
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-1467
Mailing Address - Country:US
Mailing Address - Phone:901-230-2778
Mailing Address - Fax:
Practice Address - Street 1:8684 CLEAR SKY PATH
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-1467
Practice Address - Country:US
Practice Address - Phone:901-230-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000342314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility