Healthcare Provider Details

I. General information

NPI: 1679488365
Provider Name (Legal Business Name): LEANETTE EWOENAM GAISIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEANETTE AFLAKPUI

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27920 LUCERNE DR
MENIFEE CA
92585-3508
US

IV. Provider business mailing address

28062 BAXTER RD
MURRIETA CA
92563-1401
US

V. Phone/Fax

Practice location:
  • Phone: 678-599-0090
  • Fax:
Mailing address:
  • Phone: 678-599-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95040275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: