Provider Demographics
NPI:1669539631
Name:EMENAKER, LEESA MAIRE (RN, BSN, OCN)
Entity type:Individual
Prefix:MS
First Name:LEESA
Middle Name:MAIRE
Last Name:EMENAKER
Suffix:
Gender:F
Credentials:RN, BSN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6345
Mailing Address - Country:US
Mailing Address - Phone:757-270-5830
Mailing Address - Fax:
Practice Address - Street 1:2501 OAKINGTON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5131
Practice Address - Country:US
Practice Address - Phone:410-278-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR9128107163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology