Provider Demographics
NPI:1518509157
Name:ACOSTA, LEANNA JEANNE (LPN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:JEANNE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:JEANNE
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:94-242 LEOWAHINE ST APT 22
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94-242 LEOWAHINE ST APT 22
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2108
Practice Address - Country:US
Practice Address - Phone:337-251-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19746164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse