Provider Demographics
NPI:1942710140
Name:TANNURA, LAILA RANIA (NP)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:RANIA
Last Name:TANNURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAILA
Other - Middle Name:RANIA
Other - Last Name:NOSSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:906 CAMELIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1448
Mailing Address - Country:US
Mailing Address - Phone:510-290-0680
Mailing Address - Fax:
Practice Address - Street 1:837 ADDISON ST.
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95007510OtherBOARD OF REGISTERED NURSING