Healthcare Provider Details

I. General information

NPI: 1255040119
Provider Name (Legal Business Name): WEEADA Y LEACH RNC, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MEADOWS BLVD STE 240B
CASTLE ROCK CO
80109-8405
US

IV. Provider business mailing address

106 BROKEN TEE LN
CASTLE PINES CO
80108-8726
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-3110
  • Fax: 303-649-3381
Mailing address:
  • Phone: 850-842-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0001298459
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024185454
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN.1692770
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0999198-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: