Provider Demographics
NPI:1942363668
Name:MICHEALS, LEANN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:MARIE
Last Name:MICHEALS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MURDOCH SQ SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3766
Mailing Address - Country:US
Mailing Address - Phone:703-777-3191
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER STREET
Practice Address - Street 2:RICHARD BARQUIST ARMY HEALTH CLINIC
Practice Address - City:FT. DETRICK
Practice Address - State:MD
Practice Address - Zip Code:20172
Practice Address - Country:US
Practice Address - Phone:301-619-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001142909OtherRN LICENSURE
VA0017000755OtherNP LICENSURE