Provider Demographics
NPI:1013500578
Name:LEO, JANELLE E
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:E
Last Name:LEO
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 1:1347 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2436
Mailing Address - Country:US
Mailing Address - Phone:267-439-3436
Mailing Address - Fax:
Practice Address - Street 1:1347 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2436
Practice Address - Country:US
Practice Address - Phone:267-439-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA8G952W03202OtherANTHEM BLUE CROSS