Healthcare Provider Details

I. General information

NPI: 1639725542
Provider Name (Legal Business Name): LEANA THOMPSON RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 S TUCANA LN
GILBERT AZ
85298-5713
US

IV. Provider business mailing address

6521 S TUCANA LN
GILBERT AZ
85298-5713
US

V. Phone/Fax

Practice location:
  • Phone: 978-430-9067
  • Fax:
Mailing address:
  • Phone: 978-430-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN211556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: