Healthcare Provider Details

I. General information

NPI: 1689423097
Provider Name (Legal Business Name): CHERRY LECOMPTE DNP, FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 12612
PLEASANTON CA
94588-6212
US

IV. Provider business mailing address

PO BOX 12612
PLEASANTON CA
94588-6212
US

V. Phone/Fax

Practice location:
  • Phone: 415-917-5695
  • Fax:
Mailing address:
  • Phone: 415-917-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030123
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number810813
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number810813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: