1336815174 NPI number — LEELA SCHAUNA KONRADD DNP-FNP

Table of content: LEELA SCHAUNA KONRADD DNP-FNP (NPI 1336815174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336815174 NPI number — LEELA SCHAUNA KONRADD DNP-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONRADD
Provider First Name:
LEELA
Provider Middle Name:
SCHAUNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KONRADD
Provider Other First Name:
SCHAUN
Provider Other Middle Name:
DANIEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP-FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336815174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94596-5318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 APPLE AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRYLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94541-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-470-9989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  809233 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95032583 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)