Provider Demographics
NPI:1831470418
Name:LEONARD, INGRID ANN
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:ANN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:INGRID
Other - Middle Name:ANN
Other - Last Name:FRIDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:971 N FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5825
Mailing Address - Country:US
Mailing Address - Phone:615-598-3069
Mailing Address - Fax:
Practice Address - Street 1:3380 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2262
Practice Address - Country:US
Practice Address - Phone:928-775-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP026800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse