Provider Demographics
NPI:1578734471
Name:STROUD, LEILANI JEAN (LVN11)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:JEAN
Last Name:STROUD
Suffix:
Gender:F
Credentials:LVN11
Other - Prefix:
Other - First Name:LEILANI
Other - Middle Name:JEAN
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN11
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0400
Mailing Address - Country:US
Mailing Address - Phone:530-527-5637
Mailing Address - Fax:
Practice Address - Street 1:1860 WALNUT ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3611
Practice Address - Country:US
Practice Address - Phone:530-527-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 100617164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse