Provider Demographics
NPI:1942618293
Name:LECKEY, AMANDA J (LPN, M-IV)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:LECKEY
Suffix:
Gender:F
Credentials:LPN, M-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 PINE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2425
Mailing Address - Country:US
Mailing Address - Phone:937-825-4394
Mailing Address - Fax:
Practice Address - Street 1:3522 PINE GREEN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2425
Practice Address - Country:US
Practice Address - Phone:937-825-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 141505 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse