Healthcare Provider Details

I. General information

NPI: 1003090002
Provider Name (Legal Business Name): LEAH M STREICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 09/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N BINKLEY ST
SOLDOTNA AK
99669-7523
US

IV. Provider business mailing address

PO BOX 1693
KENAI AK
99611-1693
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-9341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1118
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: