Provider Demographics
NPI:1811137631
Name:MASSIE, LEONA K (LPN)
Entity type:Individual
Prefix:MRS
First Name:LEONA
Middle Name:K
Last Name:MASSIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1046
Mailing Address - Country:US
Mailing Address - Phone:937-552-7815
Mailing Address - Fax:
Practice Address - Street 1:2412 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1046
Practice Address - Country:US
Practice Address - Phone:937-552-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN126615 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse