Provider Demographics
NPI:1659622520
Name:LEACH, JAPHIA VICTORIA (RN)
Entity Type:Individual
Prefix:
First Name:JAPHIA
Middle Name:VICTORIA
Last Name:LEACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47703-0343
Mailing Address - Country:US
Mailing Address - Phone:765-631-3320
Mailing Address - Fax:
Practice Address - Street 1:82 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1310
Practice Address - Country:US
Practice Address - Phone:765-631-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula