Provider Demographics
NPI:1851681126
Name:LEANNAN, DELIA (LAC, RN)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:LEANNAN
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 GRANT AVE
Mailing Address - Street 2:STE. 4
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-7007
Mailing Address - Country:US
Mailing Address - Phone:415-892-8272
Mailing Address - Fax:415-892-8272
Practice Address - Street 1:1310 REDWOOD WAY STE 220
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6514
Practice Address - Country:US
Practice Address - Phone:415-892-8272
Practice Address - Fax:415-892-8272
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709476163W00000X
CA13854171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse