Provider Demographics
NPI:1609303346
Name:LEONARD, THERESA (RN MSN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLYDESDALE CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5560
Mailing Address - Country:US
Mailing Address - Phone:856-574-4089
Mailing Address - Fax:
Practice Address - Street 1:13 CLYDESDALE CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5560
Practice Address - Country:US
Practice Address - Phone:856-574-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12019500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse