Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM500 | CA |
NPI | 1114456340 |
---|---|
Provider Name | Mackenzie Rose Leeke |
First Address | Nevada City, CA 95959-3014 |
Second Address | Rocklin, CA 95677-2987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2017 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114456340 | NPPES (01) | CA |