Basic Information
| Provider Information | |||||||||
| NPI: | 1770091308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MORETTI CIR APT 220 | ||||||||
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| City: | HOMEWOOD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352091939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345246989 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 MEDICAL PARK DR E | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058482925 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-135369 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.