Provider Demographics
NPI:1487395497
Name:JULES, LEONETTA I
Entity type:Individual
Prefix:
First Name:LEONETTA
Middle Name:
Last Name:JULES
Suffix:I
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 1:221 LOCH CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-5528
Mailing Address - Country:US
Mailing Address - Phone:757-656-0088
Mailing Address - Fax:
Practice Address - Street 1:1431 MERCHANT LN STE 115
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2696
Practice Address - Country:US
Practice Address - Phone:757-656-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8343077171744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA834307717Medicaid