Healthcare Provider Details

I. General information

NPI: 1710833439
Provider Name (Legal Business Name): FLAVIA R MCKLEROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT STE B
SANTA ROSA CA
95407-5454
US

IV. Provider business mailing address

751 LOMBARDI CT STE B
SANTA ROSA CA
95407-5454
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax:
Mailing address:
  • Phone: 707-303-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: