Provider Demographics
NPI:1306212774
Name:LEETH, LADAWNA R (APN)
Entity Type:Individual
Prefix:
First Name:LADAWNA
Middle Name:R
Last Name:LEETH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LADAWNA
Other - Middle Name:R
Other - Last Name:LEETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:231 HIGH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1450
Mailing Address - Country:US
Mailing Address - Phone:609-534-5998
Mailing Address - Fax:609-488-6023
Practice Address - Street 1:231 HIGH ST FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1450
Practice Address - Country:US
Practice Address - Phone:609-534-5998
Practice Address - Fax:609-488-6023
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00460100364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health