Provider Demographics
NPI:1225219660
Name:LEAL, CONCEPCION (RN)
Entity Type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3227
Mailing Address - Country:US
Mailing Address - Phone:219-397-4335
Mailing Address - Fax:219-397-4651
Practice Address - Street 1:4522 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3227
Practice Address - Country:US
Practice Address - Phone:219-397-4335
Practice Address - Fax:219-397-4651
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28126018A171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator