Provider Demographics
NPI:1376391862
Name:LEONARD, CAROLINE (BSN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CUMBERLAND ST APT 19
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-3186
Mailing Address - Country:US
Mailing Address - Phone:423-534-2078
Mailing Address - Fax:
Practice Address - Street 1:85 CUMBERLAND ST APT 19
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3186
Practice Address - Country:US
Practice Address - Phone:423-534-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000260298163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine