Provider Demographics
NPI:1245591791
Name:LEAK LEWIS, KAREN DANIELLE (CERTIFICATE)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DANIELLE
Last Name:LEAK LEWIS
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N CAPITOL ST NW
Mailing Address - Street 2:APT 401
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7583
Mailing Address - Country:US
Mailing Address - Phone:202-417-4303
Mailing Address - Fax:
Practice Address - Street 1:7506 GEOGERIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASH
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide