Healthcare Provider Details

I. General information

NPI: 1043934482
Provider Name (Legal Business Name): LEAH HEINRICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH SCHULTZE

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S MCDOWELL BLVD
PETALUMA CA
94954-3507
US

IV. Provider business mailing address

PO BOX 1335
KENWOOD CA
95452-1335
US

V. Phone/Fax

Practice location:
  • Phone: 707-293-1110
  • Fax:
Mailing address:
  • Phone: 303-868-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95022781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: