Provider Demographics
NPI:1407145907
Name:BAME, LEAH MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:BAME
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15321 FREYMAN RD
Mailing Address - Street 2:
Mailing Address - City:CYGNET
Mailing Address - State:OH
Mailing Address - Zip Code:43413-9781
Mailing Address - Country:US
Mailing Address - Phone:419-957-8545
Mailing Address - Fax:
Practice Address - Street 1:15321 FREYMAN RD
Practice Address - Street 2:
Practice Address - City:CYGNET
Practice Address - State:OH
Practice Address - Zip Code:43413-9781
Practice Address - Country:US
Practice Address - Phone:419-957-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse