Healthcare Provider Details

I. General information

NPI: 1285882829
Provider Name (Legal Business Name): LEANNE WHALEY OWENS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 S CHURTON ST
HILLSBOROUGH NC
27278-2695
US

IV. Provider business mailing address

5400 TRINITY RD STE. 105
RALEIGH NC
27607-6001
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-8131
  • Fax: 919-732-6802
Mailing address:
  • Phone: 919-851-2174
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: