Provider Demographics
NPI:1609906411
Name:DELEONARD, BRUCE PATRICK (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:PATRICK
Last Name:DELEONARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 FRAZIER DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1518
Mailing Address - Country:US
Mailing Address - Phone:509-520-1852
Mailing Address - Fax:509-529-9924
Practice Address - Street 1:KANIA CLINIC 3000 W KENNEWICK RD.
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-543-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical