Provider Demographics
NPI:1871339796
Name:LEATHERS, TANISHA MACKLIN (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:MACKLIN
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 W SLAUSON AVE # 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1290
Mailing Address - Country:US
Mailing Address - Phone:310-920-4196
Mailing Address - Fax:
Practice Address - Street 1:4859 W SLAUSON AVE # 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1290
Practice Address - Country:US
Practice Address - Phone:310-920-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95201663163WL0100X
CAL-315467163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant