Provider Demographics
NPI:1114131471
Name:LEAMON, IDA SUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:SUE
Last Name:LEAMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 EAST RD
Mailing Address - Street 2:
Mailing Address - City:POTTER VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95469-9711
Mailing Address - Country:US
Mailing Address - Phone:707-743-1726
Mailing Address - Fax:
Practice Address - Street 1:1050 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3414
Practice Address - Country:US
Practice Address - Phone:707-463-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily