Provider Demographics
NPI:1164146676
Name:ALLEN HAYWARD, LEAH MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:ALLEN HAYWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COHOCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14826-9401
Mailing Address - Country:US
Mailing Address - Phone:583-384-5310
Mailing Address - Fax:
Practice Address - Street 1:25 PARK AVE
Practice Address - Street 2:
Practice Address - City:COHOCTON
Practice Address - State:NY
Practice Address - Zip Code:14826-9401
Practice Address - Country:US
Practice Address - Phone:585-384-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine