Provider Demographics
NPI:1932612694
Name:LEIGHT, JANET ELISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ELISE
Last Name:LEIGHT
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 1:17 SAINT MARKS ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1023
Mailing Address - Country:US
Mailing Address - Phone:585-813-5109
Mailing Address - Fax:
Practice Address - Street 1:4618 OAK ORCHARD RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9435
Practice Address - Country:US
Practice Address - Phone:585-589-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152642-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152642-1Medicaid