Provider Demographics
NPI:1861103871
Name:DRAKE, LEANNA (FNP-C)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20172 E STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-2357
Mailing Address - Country:US
Mailing Address - Phone:928-632-4399
Mailing Address - Fax:
Practice Address - Street 1:20172 E STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-2357
Practice Address - Country:US
Practice Address - Phone:928-632-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ284734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine