Provider Demographics
NPI:1679297147
Name:LEAVERS, LADONNA KELLY
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:KELLY
Last Name:LEAVERS
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 1:475 1/2 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2723
Mailing Address - Country:US
Mailing Address - Phone:330-691-6701
Mailing Address - Fax:
Practice Address - Street 1:475 1/2 2ND ST NE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2723
Practice Address - Country:US
Practice Address - Phone:330-691-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide