Provider Demographics
NPI:1649614447
Name:LEON, PRISCILLA CRYSTAL (LPN)
Entity type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:CRYSTAL
Last Name:LEON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SOUTH RD APT E3
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6811
Mailing Address - Country:US
Mailing Address - Phone:845-453-0359
Mailing Address - Fax:
Practice Address - Street 1:2633 SOUTH RD APT E3
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6811
Practice Address - Country:US
Practice Address - Phone:845-453-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse