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General NPI Number Information
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NPI Number | 1538873351
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Entity Type | Individual
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Provider Name | LEAH MARIE PETERSON HAILE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 265 OAKWOOD CIR
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City | MARTINEZ
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State | CA
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Zip | 94553-3567
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Country | US
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Telephone | 616-821-8427
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Fax |
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Provider Business Mailing Address
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Address Line | 265 OAKWOOD CIR
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City | MARTINEZ
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State | CA
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Zip | 94553-3567
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Country | US
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Telephone | 616-821-8427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 67975
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10009803
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 863807
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95025265
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License Number State | CA
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