Healthcare Provider Details

I. General information

NPI: 1679161665
Provider Name (Legal Business Name): LEANN NEILSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-1228 KONA ST
MOUNTAIN VIEW HI
96771
US

IV. Provider business mailing address

16-586 OLD VOLCANO RD STE 100-3227
KEAAU HI
96749-8115
US

V. Phone/Fax

Practice location:
  • Phone: 808-797-2621
  • Fax: 808-452-1306
Mailing address:
  • Phone: 808-796-1258
  • Fax: 808-452-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3107
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: