Individual
LYNETTE LEOLA LEEPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3 EDMUND D PELLEGRINO RD, STONY BROOK, NY 11794-9460
(631) 638-0693
Mailing address
19 BOTANY LN, STONY BROOK, NY 11790-2519
(631) 721-8065
(631) 638-0660
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
302648
NY
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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