Provider Demographics
NPI:1083654677
Name:MENCHETTI, LESLIE G (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:G
Last Name:MENCHETTI
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 CORTINA DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-1699
Mailing Address - Country:US
Mailing Address - Phone:530-865-5544
Mailing Address - Fax:530-865-9209
Practice Address - Street 1:1211 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1699
Practice Address - Country:US
Practice Address - Phone:530-865-5544
Practice Address - Fax:530-865-9209
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO080771207P00000X
KS13-43718-072363LF0000X
CA22577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22577OtherCA NP LICENSE
AR163837758Medicaid
ARS63758Medicare UPIN
AR163837758Medicaid