Provider Demographics
NPI:1720550510
Name:LEONARD, ANTIONE L SR
Entity Type:Individual
Prefix:
First Name:ANTIONE
Middle Name:L
Last Name:LEONARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANTIONE
Other - Middle Name:LINDSEY
Other - Last Name:LEONARD
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:CPI CPR
Mailing Address - Street 1:6243 HOPEFUL LIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6866
Mailing Address - Country:US
Mailing Address - Phone:773-678-4733
Mailing Address - Fax:
Practice Address - Street 1:5446 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6069
Practice Address - Country:US
Practice Address - Phone:702-291-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator