Provider Demographics
NPI:1518737089
Name:ELLIOTT, LEAH ELAINE (DNP, CNM)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ELAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 APRIL ANN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4600
Mailing Address - Country:US
Mailing Address - Phone:661-204-2004
Mailing Address - Fax:
Practice Address - Street 1:1801 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-1299
Practice Address - Country:US
Practice Address - Phone:661-204-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-46789163WL0100X
CA697147163WM0102X
CANMW236421367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn