Provider Demographics
NPI:1790458917
Name:GEE-KOCH, LEONA R (LPN)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:R
Last Name:GEE-KOCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 1/2 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-3497
Mailing Address - Country:US
Mailing Address - Phone:715-571-5240
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5543
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310772-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse