Provider Demographics
NPI:1427250554
Name:LEBARON, DONNA LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNN
Last Name:LEBARON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MCCLELLAN WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3649
Mailing Address - Country:US
Mailing Address - Phone:209-952-7626
Mailing Address - Fax:
Practice Address - Street 1:1041 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0001
Practice Address - Country:US
Practice Address - Phone:209-946-2315
Practice Address - Fax:209-945-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health