Provider Demographics
NPI:1508558990
Name:HURTEAU, LEONARD DEWAYNE
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:DEWAYNE
Last Name:HURTEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4797 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9703
Mailing Address - Country:US
Mailing Address - Phone:315-345-0564
Mailing Address - Fax:
Practice Address - Street 1:4797 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9703
Practice Address - Country:US
Practice Address - Phone:315-345-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334672-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily