Provider Demographics
NPI:1295503340
Name:LEONARD, BRYAN ROBERT (NP)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ROBERT
Last Name:LEONARD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:ROBERT
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:19719 SUTTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-9725
Mailing Address - Country:US
Mailing Address - Phone:209-296-1643
Mailing Address - Fax:
Practice Address - Street 1:6611 FOLSOM AUBURN RD STE F
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2100
Practice Address - Country:US
Practice Address - Phone:916-988-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027967363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health