Provider Demographics
NPI:1598999112
Name:LEASURE, JENNIFER MARIE (CSTO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:LEASURE
Suffix:
Gender:F
Credentials:CSTO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SHERIDAN DR APT 12D
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1957
Mailing Address - Country:US
Mailing Address - Phone:740-407-8609
Mailing Address - Fax:
Practice Address - Street 1:1410 SHERIDAN DR APT 12D
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1957
Practice Address - Country:US
Practice Address - Phone:740-407-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376KOOOOOX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant