Provider Demographics
NPI:1740358605
Name:PAUL, LE'ANNA STJOHN (PA-C)
Entity type:Individual
Prefix:
First Name:LE'ANNA
Middle Name:STJOHN
Last Name:PAUL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LE'ANNA
Other - Middle Name:SHANNON
Other - Last Name:STJOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2029 SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2101
Mailing Address - Country:US
Mailing Address - Phone:707-756-0392
Mailing Address - Fax:
Practice Address - Street 1:1143 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6007
Practice Address - Country:US
Practice Address - Phone:707-756-0392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17603363A00000X
HIAMD-889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant