Provider Demographics
NPI:1164638599
Name:LEOPOLD, FRANNIE (PA 11942)
Entity Type:Individual
Prefix:
First Name:FRANNIE
Middle Name:
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:PA 11942
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 1093
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460
Mailing Address - Country:US
Mailing Address - Phone:707-964-0017
Mailing Address - Fax:
Practice Address - Street 1:850 SEQUOIA CIRCLE
Practice Address - Street 2:WOMENS HEALTH CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-0259
Practice Address - Fax:707-964-0765
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 11942OtherLICENSE