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Individual

TIERNEY C LEACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14860 JOLENTA LN, ELM GROVE, WI 53122-1025
(414) 378-6224
Mailing address
6880 W GRANTOSA DR, MILWAUKEE, WI 53218-2907
(414) 202-8382

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3214002
WI

Other

Enumeration date
08/18/2019
Last updated
08/18/2019
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