Provider Demographics
NPI:1861825267
Name:MINIE, LEYISH
Entity Type:Individual
Prefix:
First Name:LEYISH
Middle Name:
Last Name:MINIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 TIFFANY PARK CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:301-257-3120
Mailing Address - Fax:
Practice Address - Street 1:9051 TIFFANY PARK CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2160
Practice Address - Country:US
Practice Address - Phone:301-257-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001156287163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator