Healthcare Provider Details

I. General information

NPI: 1871763177
Provider Name (Legal Business Name): LEAH MICHELLE LIN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 W CHARLESTON BLVD
LAS VEGAS NV
89102-1932
US

IV. Provider business mailing address

701 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-7776
  • Fax: 707-878-7078
Mailing address:
  • Phone: 505-265-9511
  • Fax: 505-814-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number081476
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number741506 OR 18750
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number822113
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: