Provider Demographics
NPI:1639725542
Name:THOMPSON, LEANA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:LEANA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 S TUCANA LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-5713
Mailing Address - Country:US
Mailing Address - Phone:978-430-9067
Mailing Address - Fax:
Practice Address - Street 1:6521 S TUCANA LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-5713
Practice Address - Country:US
Practice Address - Phone:978-430-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN211556163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant