Provider Demographics
NPI:1568018638
Name:LECLAIR, JEANMARIE ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:ELIZABETH
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3303
Mailing Address - Country:US
Mailing Address - Phone:414-807-5227
Mailing Address - Fax:
Practice Address - Street 1:1133 N 119TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3303
Practice Address - Country:US
Practice Address - Phone:414-807-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161027-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse