Provider Demographics
NPI:1245616788
Name:MUNACO, LEANN NICOLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:NICOLE
Last Name:MUNACO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3232
Mailing Address - Country:US
Mailing Address - Phone:586-447-4200
Mailing Address - Fax:586-447-4208
Practice Address - Street 1:21300 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3232
Practice Address - Country:US
Practice Address - Phone:586-447-4200
Practice Address - Fax:586-447-4208
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270312363LF0000X
MI470427012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse