Provider Demographics
NPI:1730178724
Name:LEONARD, CHERYL JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:JEAN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 TORTUGA ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-2406
Mailing Address - Country:US
Mailing Address - Phone:661-269-0639
Mailing Address - Fax:
Practice Address - Street 1:2109 TORTUGA ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-2406
Practice Address - Country:US
Practice Address - Phone:661-269-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner