Individual
NANCY S. LEAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
103 S MAIN ST, MIDDLETOWN, CT 06457-3651
(860) 358-8760
(860) 358-8754
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-8760
(860) 358-8754
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1012
CT
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
001012
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001012
APRN CONN LICENSE
CT
Enumeration date
02/25/2006
Last updated
03/05/2012
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