Provider Demographics
NPI:1194001412
Name:LEIGH, ANGELA GRACE (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GRACE
Last Name:LEIGH
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 COWELL ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6916
Mailing Address - Country:US
Mailing Address - Phone:918-576-8610
Mailing Address - Fax:
Practice Address - Street 1:923 COWELL ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6916
Practice Address - Country:US
Practice Address - Phone:918-576-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic