Provider Demographics
NPI:1407359193
Name:PENECALE, LESLIE (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:PENECALE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942-9512
Mailing Address - Country:US
Mailing Address - Phone:215-460-5986
Mailing Address - Fax:
Practice Address - Street 1:949 NEW HOLLAND RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-1646
Practice Address - Country:US
Practice Address - Phone:484-628-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN23190L163WL0100X
PARN231907L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty