Provider Demographics
NPI:1740857523
Name:HERN, LEANNE R (STNA)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:R
Last Name:HERN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 SWING A LONG LN
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9599
Mailing Address - Country:US
Mailing Address - Phone:740-319-8426
Mailing Address - Fax:
Practice Address - Street 1:6715 SWING A LONG LN
Practice Address - Street 2:
Practice Address - City:NASHPORT
Practice Address - State:OH
Practice Address - Zip Code:43830-9599
Practice Address - Country:US
Practice Address - Phone:740-319-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401787820915374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide