Healthcare Provider Details

I. General information

NPI: 1447483987
Provider Name (Legal Business Name): LEIGHANNE K LARSON SCHULTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGHANNE K VANSICKLER PA-C

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 200
LANSING MI
48912-1806
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: