Provider Demographics
NPI:1285852988
Name:JURY, LEONARD EDWIN (EMP CLPN)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:EDWIN
Last Name:JURY
Suffix:
Gender:M
Credentials:EMP CLPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9721
Mailing Address - Country:US
Mailing Address - Phone:440-964-2361
Mailing Address - Fax:440-964-0130
Practice Address - Street 1:615 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3262
Practice Address - Country:US
Practice Address - Phone:440-964-2361
Practice Address - Fax:440-964-0130
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 071984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse