Provider Demographics
NPI:1750675732
Name:LEATHERSICH, MAUREEN RITA (RN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:RITA
Last Name:LEATHERSICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:RITA
Other - Last Name:LAMOREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:NY
Mailing Address - Zip Code:14485-0487
Mailing Address - Country:US
Mailing Address - Phone:585-748-1883
Mailing Address - Fax:
Practice Address - Street 1:1775 BETHEL DR # 7
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-9757
Practice Address - Country:US
Practice Address - Phone:585-748-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478297-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse