Healthcare Provider Details

I. General information

NPI: 1922481951
Provider Name (Legal Business Name): LEIGHANNE SHIREY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 DIAMOND VALLEY RD UNIT B
MARKLEEVILLE CA
96120-9579
US

IV. Provider business mailing address

52 S MAIN ST
ANGELS CAMP CA
95222-9153
US

V. Phone/Fax

Practice location:
  • Phone: 530-694-2146
  • Fax: 530-694-2770
Mailing address:
  • Phone: 209-754-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001945
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: