Provider Demographics
NPI:1942710355
Name:LEON, GENNA M (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:M
Last Name:LEON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9373
Mailing Address - Country:US
Mailing Address - Phone:559-970-5608
Mailing Address - Fax:
Practice Address - Street 1:2111 HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6301
Practice Address - Country:US
Practice Address - Phone:559-299-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily