Provider Demographics
NPI:1801814405
Name:LEAKE, ANNE REYNOLDS (APRN)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:REYNOLDS
Last Name:LEAKE
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1301 PUNCHBOWL ST.
Mailing Address - Street 2:CLARK APT 411
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96713
Mailing Address - Country:US
Mailing Address - Phone:808-691-5309
Mailing Address - Fax:808-691-7822
Practice Address - Street 1:45-260 WAIKALUA RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3516
Practice Address - Country:US
Practice Address - Phone:808-234-5562
Practice Address - Fax:808-650-5031
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN-77363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI497190Medicaid
H51326Medicare ID - Type Unspecified
HI51863103Medicare ID - Type Unspecified