Provider Demographics
NPI:1215593850
Name:MCLEOD, EMERALD (NP-C)
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SANTA BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1472
Mailing Address - Country:US
Mailing Address - Phone:805-550-9007
Mailing Address - Fax:
Practice Address - Street 1:1242 MONTEREY ST STE 130
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-0808
Practice Address - Country:US
Practice Address - Phone:805-550-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily