Provider Demographics
NPI:1326581331
Name:LEISZ, MARGARET FRANCES (FNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:FRANCES
Last Name:LEISZ
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 1:841 VERANO AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-5430
Mailing Address - Country:US
Mailing Address - Phone:707-235-5168
Mailing Address - Fax:
Practice Address - Street 1:181 ANDRIEUX ST
Practice Address - Street 2:SUITE #202
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6932
Practice Address - Country:US
Practice Address - Phone:707-933-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily