Individual
LYDIA JORDAN LEONARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3190 NORTHRIDGE RD, HALE, MI 48739-9276
(989) 728-6000
(989) 728-6003
Mailing address
3190 NORTHRIDGE DRIVE, HALE, MI 48739
(989) 728-6000
(989) 728-6003
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704292824
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704292824
NURSE PRACTITIONER LICENSE
MI
Enumeration date
06/20/2017
Last updated
07/21/2022
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