Provider Demographics
NPI:1548911639
Name:DUNLEAVY, ILLISHA KAUR (FNP)
Entity type:Individual
Prefix:
First Name:ILLISHA
Middle Name:KAUR
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ILLISHA
Other - Middle Name:KAUR
Other - Last Name:RAJASANSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5980 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6809
Mailing Address - Country:US
Mailing Address - Phone:408-507-8124
Mailing Address - Fax:
Practice Address - Street 1:2371 OWEN ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3212
Practice Address - Country:US
Practice Address - Phone:408-708-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner