Provider Demographics
NPI:1346400942
Name:LEACH, DIANNE (NP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:3520 GUION ROAD
Mailing Address - Street 2:STE 303
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1692
Mailing Address - Country:US
Mailing Address - Phone:317-920-3220
Mailing Address - Fax:317-920-3221
Practice Address - Street 1:3520 GUION ROAD
Practice Address - Street 2:STE 303
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1692
Practice Address - Country:US
Practice Address - Phone:317-920-3220
Practice Address - Fax:317-920-3221
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002649B208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
INML1776686OtherDEA