Healthcare Provider Details

I. General information

NPI: 1811622103
Provider Name (Legal Business Name): LEIGHERIN HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD # 3200
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

4154 ARENZANO WAY
EL DORADO HILLS CA
95762-5454
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number843251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: