Provider Demographics
NPI:1114696242
Name:DUVALIER, LEANNE
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:DUVALIER
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 1:8703 W SAMPLE RD APT 111
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4442
Mailing Address - Country:US
Mailing Address - Phone:850-316-0614
Mailing Address - Fax:
Practice Address - Street 1:8703 W SAMPLE RD APT 111
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4442
Practice Address - Country:US
Practice Address - Phone:850-316-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date: