Provider Demographics
NPI:1043934482
Name:HEINRICH, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:KENWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:95452-1335
Mailing Address - Country:US
Mailing Address - Phone:303-868-6268
Mailing Address - Fax:
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:303-868-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022781363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health