Provider Demographics
NPI:1114552361
Name:MERKWA, LEEANNE JESSICA (RN)
Entity Type:Individual
Prefix:
First Name:LEEANNE
Middle Name:JESSICA
Last Name:MERKWA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEEANNE
Other - Middle Name:JESSICA
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3392 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2252
Mailing Address - Country:US
Mailing Address - Phone:716-244-0332
Mailing Address - Fax:
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2001
Practice Address - Country:US
Practice Address - Phone:716-710-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594376163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse