Provider Demographics
NPI:1790291839
Name:BRISCOE, LEILIN ELIZABETH (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LEILIN
Middle Name:ELIZABETH
Last Name:BRISCOE
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 1:7087 WHEELER CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3240
Mailing Address - Country:US
Mailing Address - Phone:909-684-2479
Mailing Address - Fax:
Practice Address - Street 1:1173 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3523
Practice Address - Country:US
Practice Address - Phone:909-884-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695083164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW238027277OtherAETNA