Provider Demographics
NPI:1801644141
Name:LEEDLE, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LEEDLE
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 1:2490 TITANS LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3731
Mailing Address - Country:US
Mailing Address - Phone:615-925-3894
Mailing Address - Fax:615-658-8420
Practice Address - Street 1:750 OLD HICKORY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5387
Practice Address - Country:US
Practice Address - Phone:615-925-3894
Practice Address - Fax:615-658-8420
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach