Provider Demographics
NPI:1194841577
Name:LEONARD, ESTELLE L
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:L
Last Name:LEONARD
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 1:8819 SEABRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9574
Mailing Address - Country:US
Mailing Address - Phone:614-571-0399
Mailing Address - Fax:614-932-9209
Practice Address - Street 1:8819 SEABRIGHT DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9574
Practice Address - Country:US
Practice Address - Phone:614-571-0399
Practice Address - Fax:614-932-9209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT404620374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2648915OtherINDEPENDENT CARE PROVIDER