Provider Demographics
NPI:1629727730
Name:LEKE, RENIE
Entity Type:Individual
Prefix:
First Name:RENIE
Middle Name:
Last Name:LEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 HEATHWICK CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3258
Mailing Address - Country:US
Mailing Address - Phone:301-477-2128
Mailing Address - Fax:
Practice Address - Street 1:13994 BALTIMORE AVE # 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5087
Practice Address - Country:US
Practice Address - Phone:301-477-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004226163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health