Provider Demographics
NPI:1689142119
Name:LEECH, LAURA KRISTIN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KRISTIN
Last Name:LEECH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:NE
Mailing Address - Zip Code:68376-6111
Mailing Address - Country:US
Mailing Address - Phone:402-862-2151
Mailing Address - Fax:402-862-2152
Practice Address - Street 1:810 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:NE
Practice Address - Zip Code:68376-6111
Practice Address - Country:US
Practice Address - Phone:402-862-2151
Practice Address - Fax:402-862-2152
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60076163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool