Provider Demographics
NPI:1679332332
Name:FAY, LEA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:FAY
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 1:9840 HYACINTH WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8109
Mailing Address - Country:US
Mailing Address - Phone:973-592-9130
Mailing Address - Fax:
Practice Address - Street 1:9840 HYACINTH WAY
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8109
Practice Address - Country:US
Practice Address - Phone:973-592-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare