Provider Demographics
NPI:1558721266
Name:CROSS, LEANORA I
Entity Type:Individual
Prefix:
First Name:LEANORA
Middle Name:
Last Name:CROSS
Suffix:I
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 1:21908 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1207
Mailing Address - Country:US
Mailing Address - Phone:347-303-7421
Mailing Address - Fax:
Practice Address - Street 1:21908 130TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1207
Practice Address - Country:US
Practice Address - Phone:347-303-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide