Provider Demographics
NPI:1669741161
Name:LEACH, BARBARA R (RN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:R
Last Name:LEACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:NY
Mailing Address - Zip Code:14855-0081
Mailing Address - Country:US
Mailing Address - Phone:607-792-3675
Mailing Address - Fax:607-792-3749
Practice Address - Street 1:3769 STATE ROUTE 417
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:NY
Practice Address - Zip Code:14855
Practice Address - Country:US
Practice Address - Phone:607-792-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445547-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool