Provider Demographics
NPI:1558321851
Name:MCLEOD, LEANN K (PA-C)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:K
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:K
Other - Last Name:VAN WYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:666 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:666 PHEASANT DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4006
Practice Address - Country:US
Practice Address - Phone:323-223-6833
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS98772Medicare UPIN