Healthcare Provider Details

I. General information

NPI: 1942657234
Provider Name (Legal Business Name): LEANNA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 HUMBOLDT RD SUITE 200
CHICO CA
95928-9203
US

IV. Provider business mailing address

1442 ETHAN WAY SUITE 200
SACRAMENTO CA
95825-2231
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-1917
  • Fax:
Mailing address:
  • Phone: 916-482-4856
  • Fax: 530-893-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95085929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: