Provider Demographics
NPI:1386178317
Name:TOVAR, LEANNA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:TOVAR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-2810
Mailing Address - Country:US
Mailing Address - Phone:209-761-4077
Mailing Address - Fax:209-383-5262
Practice Address - Street 1:2310 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-2810
Practice Address - Country:US
Practice Address - Phone:209-761-4077
Practice Address - Fax:209-383-5262
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA686168164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse