Provider Demographics
NPI:1811225659
Name:LEONARD, VIRGINIA SUE (RN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 E HIGH ST UNIT 221
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5447
Mailing Address - Country:US
Mailing Address - Phone:480-239-2586
Mailing Address - Fax:
Practice Address - Street 1:5355 E HIGH ST UNIT 221
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5447
Practice Address - Country:US
Practice Address - Phone:480-239-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156254163W00000X, 163WH0200X, 163WH1000X, 163WI0500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN156254OtherRN