Provider Demographics
NPI:1609364397
Name:LYAKHOVICH, LEONARD (RNFA)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:LYAKHOVICH
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WAYMAN LN
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1625
Mailing Address - Country:US
Mailing Address - Phone:207-288-5082
Mailing Address - Fax:207-288-9626
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5082
Practice Address - Fax:207-288-9626
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN50897163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant