Provider Demographics
NPI:1255494340
Name:LEON, DONNA A (LIC AC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:LEON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MULPUS RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1829
Mailing Address - Country:US
Mailing Address - Phone:978-635-9122
Mailing Address - Fax:
Practice Address - Street 1:421 MULPUS RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1829
Practice Address - Country:US
Practice Address - Phone:978-635-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist