MEDICARE: ANNE MICHELLE R. DE LEON NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	688046	CA
2	363LF0000X	Family Nurse Practitioner	21553	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21553	OTHER	CA	NURSE PRACTITIONER FURNISHING NUMBER
2	F0114589	OTHER	CA	BOARD CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1952695694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MICHELLE R. DE LEON NP-C

Provider Business Mailing Address
First Line	:	1026 2ND ST
Second Line	:	APT 35
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3970
Country	:	US
Telephone Number	:	510-677-0321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 2ND ST
Second Line	:	APT 35
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3970
Country	:	US
Telephone Number	:	510-577-0321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2011
Last Update Date	:	03/07/2023

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