Provider Demographics
NPI:1316757958
Name:LEONARD, MICHELLE (RN, PHN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:CA
Mailing Address - Zip Code:95439-8837
Mailing Address - Country:US
Mailing Address - Phone:408-637-1474
Mailing Address - Fax:
Practice Address - Street 1:1691 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5903
Practice Address - Country:US
Practice Address - Phone:707-609-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95320497163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool