Provider Demographics
NPI:1245762640
Name:ADAN, LEEANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:
Last Name:ADAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9986 KAUFMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5107
Mailing Address - Country:US
Mailing Address - Phone:858-722-1772
Mailing Address - Fax:
Practice Address - Street 1:1600 PACIFIC HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2429
Practice Address - Country:US
Practice Address - Phone:858-722-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830446163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse