Provider Demographics
NPI:1346225067
Name:LEONARD, THERESA M (CRNA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S BROAD ST
Mailing Address - Street 2:1ST FLOOR, METHODIST HOSPITAL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3542
Mailing Address - Country:US
Mailing Address - Phone:215-952-9323
Mailing Address - Fax:215-952-1246
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:1ST FLOOR, METHODIST HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-9323
Practice Address - Fax:215-952-1246
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 251183L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01975589-0001Medicaid
PA0019755890 024Medicaid
PA01975589-0001Medicaid