Provider Demographics
NPI:1295446268
Name:QUESENBERRY, LEANDREA DAWN (PRSS)
Entity type:Individual
Prefix:
First Name:LEANDREA
Middle Name:DAWN
Last Name:QUESENBERRY
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 QUARRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1843
Mailing Address - Country:US
Mailing Address - Phone:681-340-1979
Mailing Address - Fax:
Practice Address - Street 1:1206 QUARRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1843
Practice Address - Country:US
Practice Address - Phone:681-340-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21-397175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist