Provider Demographics
NPI:1255495560
Name:LEARY, MICHELE JEANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:JEANNE
Last Name:LEARY
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 1:35 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-2911
Mailing Address - Country:US
Mailing Address - Phone:781-891-9252
Mailing Address - Fax:
Practice Address - Street 1:35 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-2911
Practice Address - Country:US
Practice Address - Phone:781-891-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143065163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health