Provider Demographics
NPI:1669027827
Name:MCKEOUGH, LEANNA (LVN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:MCKEOUGH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82485 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4249
Mailing Address - Country:US
Mailing Address - Phone:760-342-8200
Mailing Address - Fax:
Practice Address - Street 1:82485 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4249
Practice Address - Country:US
Practice Address - Phone:760-342-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218281164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse