Provider Demographics
NPI:1609160316
Name:LEARY, JENNIFER M (APN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LEARY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4460
Mailing Address - Country:US
Mailing Address - Phone:775-322-3393
Mailing Address - Fax:775-322-3385
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4460
Practice Address - Country:US
Practice Address - Phone:775-322-3393
Practice Address - Fax:775-322-3385
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001277363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care