Provider Demographics
NPI:1275390247
Name:LEOPOLD, DONALD ALLEN
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ALLEN
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 14TH ST STE 218
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3270
Mailing Address - Country:US
Mailing Address - Phone:402-469-1234
Mailing Address - Fax:402-303-6452
Practice Address - Street 1:223 E 14TH ST STE 218
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3270
Practice Address - Country:US
Practice Address - Phone:402-469-1234
Practice Address - Fax:402-303-6452
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEB-01705343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)