Provider Demographics
NPI:1336900927
Name:LECKEMBY, TAIRRA
Entity Type:Individual
Prefix:
First Name:TAIRRA
Middle Name:
Last Name:LECKEMBY
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 1:188 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:ADAH
Mailing Address - State:PA
Mailing Address - Zip Code:15410-1135
Mailing Address - Country:US
Mailing Address - Phone:724-320-5634
Mailing Address - Fax:
Practice Address - Street 1:188 MURPHY RD
Practice Address - Street 2:
Practice Address - City:ADAH
Practice Address - State:PA
Practice Address - Zip Code:15410-1135
Practice Address - Country:US
Practice Address - Phone:724-320-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-301476174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN