Provider Demographics
NPI:1104155381
Name:LEEDS, ADRIENNE R (RM, CPM)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:R
Last Name:LEEDS
Suffix:
Gender:F
Credentials:RM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 CLOVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7577
Mailing Address - Country:US
Mailing Address - Phone:843-709-8068
Mailing Address - Fax:
Practice Address - Street 1:1736 CLOVER CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503
Practice Address - Country:US
Practice Address - Phone:843-709-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW-0042176B00000X
COMWR.0000177176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife