Provider Demographics
NPI:1700101466
Name:OLDENBROOK, LEANNE MARY
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:MARY
Last Name:OLDENBROOK
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 1:14 CONANT DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2609
Mailing Address - Country:US
Mailing Address - Phone:716-864-1194
Mailing Address - Fax:
Practice Address - Street 1:495 SKINNERSVILLE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2502
Practice Address - Country:US
Practice Address - Phone:716-864-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
178804378OtherDUNS