Provider Demographics
NPI:1437260619
Name:DE SILVA, LEANNE NADINE (MSN, FNP-C, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:NADINE
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:MSN, FNP-C, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KING ST
Mailing Address - Street 2:
Mailing Address - City:ARBUCKLE
Mailing Address - State:CA
Mailing Address - Zip Code:95912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 KING ST
Practice Address - Street 2:
Practice Address - City:ARBUCKLE
Practice Address - State:CA
Practice Address - Zip Code:95912
Practice Address - Country:US
Practice Address - Phone:530-476-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11867363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP18434Medicare UPIN