Provider Demographics
NPI:1952695694
Name:DE LEON, ANNE MICHELLE R (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNE MICHELLE
Middle Name:R
Last Name:DE LEON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 2ND ST
Mailing Address - Street 2:APT 35
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3970
Mailing Address - Country:US
Mailing Address - Phone:510-677-0321
Mailing Address - Fax:
Practice Address - Street 1:1026 2ND ST
Practice Address - Street 2:APT 35
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3970
Practice Address - Country:US
Practice Address - Phone:510-577-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA688046163W00000X
CA21553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21553OtherNURSE PRACTITIONER FURNISHING NUMBER
CAF0114589OtherBOARD CERTIFICATION NUMBER
CAMD2832992OtherDEA REGISTRATION NUMBER