Provider Demographics
NPI:1770688665
Name:STAPLES, LEAH LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:LYNN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 KILLARNEY LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5498
Mailing Address - Country:US
Mailing Address - Phone:219-531-9304
Mailing Address - Fax:
Practice Address - Street 1:1201 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1705
Practice Address - Country:US
Practice Address - Phone:219-880-1190
Practice Address - Fax:219-880-0784
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000126A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology