Provider Demographics
NPI:1649853342
Name:GREEN, LEAH MARIE (LVN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:GREEN
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 1:6600 INTERNATIONAL BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3625
Mailing Address - Country:US
Mailing Address - Phone:510-246-9554
Mailing Address - Fax:
Practice Address - Street 1:10429 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-3221
Practice Address - Country:US
Practice Address - Phone:510-777-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN709190164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse