Provider Demographics
NPI:1710206073
Name:LEAK, JANICE ELAINE (MSN, APRN-BC, AOCN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ELAINE
Last Name:LEAK
Suffix:
Gender:F
Credentials:MSN, APRN-BC, AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8111 S EMERSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8601
Mailing Address - Country:US
Mailing Address - Phone:317-859-5252
Mailing Address - Fax:317-859-5258
Practice Address - Street 1:8111 S EMERSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8601
Practice Address - Country:US
Practice Address - Phone:317-859-5252
Practice Address - Fax:317-859-5258
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003236A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner