Provider Demographics
NPI:1487791091
Name:LEONARDI, JOSEPH EUGENE (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:LEONARDI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-223-9400
Mailing Address - Fax:217-223-9552
Practice Address - Street 1:1005 BROADWAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-223-9400
Practice Address - Fax:217-223-9552
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000924367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL380140Medicare ID - Type Unspecified