Provider Demographics
NPI:1437750080
Name:CUMMINS-MEADE, LESLEE BROOKE
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:BROOKE
Last Name:CUMMINS-MEADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2810
Mailing Address - Country:US
Mailing Address - Phone:580-920-2069
Mailing Address - Fax:580-920-1010
Practice Address - Street 1:1312 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2810
Practice Address - Country:US
Practice Address - Phone:580-920-2069
Practice Address - Fax:580-920-1010
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator