Provider Demographics
NPI:1689391542
Name:DOLL, LEEANNA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:NICOLE
Last Name:DOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEEANNA
Other - Middle Name:NICOLE
Other - Last Name:MAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2673 DAVISSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-6838
Mailing Address - Country:US
Mailing Address - Phone:681-342-3200
Mailing Address - Fax:304-622-9458
Practice Address - Street 1:2673 DAVISSON RUN RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6838
Practice Address - Country:US
Practice Address - Phone:681-342-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83332163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health