Provider Demographics
NPI:1366844771
Name:SMITH, LEANA (MS, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEANA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 HANLON WAY
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3653
Mailing Address - Country:US
Mailing Address - Phone:424-777-5704
Mailing Address - Fax:
Practice Address - Street 1:864 HANLON WAY
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3653
Practice Address - Country:US
Practice Address - Phone:424-777-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health