Provider Demographics
NPI:1750457180
Name:LEAKE, CARMIE (RN, OCN)
Entity Type:Individual
Prefix:
First Name:CARMIE
Middle Name:
Last Name:LEAKE
Suffix:
Gender:F
Credentials:RN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 21ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1135
Mailing Address - Country:US
Mailing Address - Phone:806-793-6654
Mailing Address - Fax:806-793-7871
Practice Address - Street 1:4002 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1135
Practice Address - Country:US
Practice Address - Phone:806-793-6654
Practice Address - Fax:806-793-7871
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620496163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology