Provider Demographics
NPI:1215552724
Name:LEONELLI, TAELOR
Entity Type:Individual
Prefix:
First Name:TAELOR
Middle Name:
Last Name:LEONELLI
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 1:151 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2141
Mailing Address - Country:US
Mailing Address - Phone:435-277-2300
Mailing Address - Fax:435-277-2304
Practice Address - Street 1:151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2141
Practice Address - Country:US
Practice Address - Phone:435-277-2300
Practice Address - Fax:435-277-2304
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11579633-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management