Provider Demographics
NPI:1831462084
Name:LEACH, MARQUETTE (RN)
Entity Type:Individual
Prefix:
First Name:MARQUETTE
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 16TH ST
Mailing Address - Street 2:5J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6306
Mailing Address - Country:US
Mailing Address - Phone:917-815-8412
Mailing Address - Fax:
Practice Address - Street 1:27 W 16TH ST
Practice Address - Street 2:5J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6306
Practice Address - Country:US
Practice Address - Phone:917-815-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022138067363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty