Provider Demographics
NPI:1780427013
Name:LEACH, AVADAWN GISELE
Entity type:Individual
Prefix:
First Name:AVADAWN
Middle Name:GISELE
Last Name:LEACH
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 1:3028 MIARS GRN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4267
Mailing Address - Country:US
Mailing Address - Phone:910-853-4006
Mailing Address - Fax:
Practice Address - Street 1:3028 MIARS GRN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4267
Practice Address - Country:US
Practice Address - Phone:910-853-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide