Provider Demographics
NPI:1184034654
Name:LEONARD, ADAM JOHN (NP, RN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:LEONARD
Suffix:
Gender:M
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 COLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2800
Mailing Address - Country:US
Mailing Address - Phone:415-751-8181
Mailing Address - Fax:415-831-4524
Practice Address - Street 1:555 COLE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2800
Practice Address - Country:US
Practice Address - Phone:415-751-8181
Practice Address - Fax:415-831-4524
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA824952163W00000X
CA95000965965363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYMCRMedicare UPIN