Provider Demographics
NPI:1497938021
Name:LEONARD, SHELBY ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ANN
Last Name:LEONARD
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 1:500 E 3RD ST
Mailing Address - Street 2:430
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5103
Mailing Address - Country:US
Mailing Address - Phone:937-270-9378
Mailing Address - Fax:937-684-4387
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:APT#430
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-5103
Practice Address - Country:US
Practice Address - Phone:937-270-9378
Practice Address - Fax:937-684-4387
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 112774164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse