Provider Demographics
NPI:1275416323
Name:JUSTUS, LEANDRA
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938-0064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21935 MIDLAND TRAIL
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:WV
Practice Address - Zip Code:25938
Practice Address - Country:US
Practice Address - Phone:394-578-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide