Provider Demographics
NPI:1760051742
Name:GIBSON-WENTE, LEAH MELISA (NURSE PRACTITIONRE)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MELISA
Last Name:GIBSON-WENTE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 TOYON CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1154
Mailing Address - Country:US
Mailing Address - Phone:919-608-2427
Mailing Address - Fax:
Practice Address - Street 1:869 TOYON CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1154
Practice Address - Country:US
Practice Address - Phone:919-608-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95166838163WG0000X
NCRN204838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice