Provider Demographics
NPI:1326551060
Name:MORALES, LEANN WATSON (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:WATSON
Last Name:MORALES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 MEADOWBRIDGE RD STE 305
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2339
Mailing Address - Country:US
Mailing Address - Phone:804-764-6218
Mailing Address - Fax:
Practice Address - Street 1:8220 MEADOWBRIDGE RD STE 305
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2339
Practice Address - Country:US
Practice Address - Phone:804-287-4588
Practice Address - Fax:804-287-4588
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA972510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered