Provider Demographics
NPI:1538873351
Name:HAILE, LEAH MARIE PETERSON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE PETERSON
Last Name:HAILE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3567
Mailing Address - Country:US
Mailing Address - Phone:616-821-8427
Mailing Address - Fax:
Practice Address - Street 1:265 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3567
Practice Address - Country:US
Practice Address - Phone:616-821-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID67975363LP0808X
OR10009803363LP0808X
NV863807363LP0808X
CA95025265363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health