Provider Demographics
NPI:1366196164
Name:HARRISON, LEAH (LVN)
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PROSPECT WAY # 1
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-3062
Mailing Address - Country:US
Mailing Address - Phone:510-827-8058
Mailing Address - Fax:707-564-3375
Practice Address - Street 1:1423 PROSPECT WAY # 1
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-3062
Practice Address - Country:US
Practice Address - Phone:510-827-8058
Practice Address - Fax:707-564-3375
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN720075164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty