Healthcare Provider Details

I. General information

NPI: 1093033169
Provider Name (Legal Business Name): HEATHER LEUTWYLER RN, FNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 OCEANVIEW TER #404
SAN FRANCISCO CA
94132-3282
US

IV. Provider business mailing address

2 KORET WAY, BOX 0610
SAN FRANCISCO CA
94143-0610
US

V. Phone/Fax

Practice location:
  • Phone: 415-341-5344
  • Fax:
Mailing address:
  • Phone: 415-341-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number651046
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: