Provider Demographics
NPI:1568048585
Name:LEIDY, LISA A (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:LEIDY
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 1:156 S STATE STREET ALY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7348
Mailing Address - Country:US
Mailing Address - Phone:302-674-2380
Mailing Address - Fax:
Practice Address - Street 1:156 S STATE STREET ALY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7348
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0067103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse