Provider Demographics
NPI:1881038974
Name:TYREE, LEILAH M (CNM)
Entity Type:Individual
Prefix:
First Name:LEILAH
Middle Name:M
Last Name:TYREE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 BOONTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1510
Mailing Address - Country:US
Mailing Address - Phone:973-985-2799
Mailing Address - Fax:
Practice Address - Street 1:514 BOONTON AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1510
Practice Address - Country:US
Practice Address - Phone:973-985-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00046100367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife