Provider Demographics
NPI:1174896047
Name:FRANCIS, LEASTA MARIA (LPN)
Entity type:Individual
Prefix:MS
First Name:LEASTA
Middle Name:MARIA
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:MARIA
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:804 E 138TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1902
Mailing Address - Country:US
Mailing Address - Phone:646-460-3680
Mailing Address - Fax:
Practice Address - Street 1:804 E 138TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1902
Practice Address - Country:US
Practice Address - Phone:718-665-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306833-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse