Provider Demographics
NPI:1639186067
Name:LEONARD, JUDITH WHITNEY (PNP, BC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:WHITNEY
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:23321 EL TORO RD
Mailing Address - Street 2:SUITES F & G
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4825
Mailing Address - Country:US
Mailing Address - Phone:949-770-0513
Mailing Address - Fax:949-770-2941
Practice Address - Street 1:23321 EL TORO RD
Practice Address - Street 2:SUITES F & G
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4825
Practice Address - Country:US
Practice Address - Phone:949-770-0513
Practice Address - Fax:949-770-2941
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374842363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ8391ZMedicaid