Provider Demographics
NPI:1639963770
Name:LEETH, BIANCA MARIE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MARIE
Last Name:LEETH
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 1:197 E GROVE ST APT D3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3756
Mailing Address - Country:US
Mailing Address - Phone:775-399-1607
Mailing Address - Fax:
Practice Address - Street 1:197 E GROVE ST APT D3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3756
Practice Address - Country:US
Practice Address - Phone:775-399-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide