Healthcare Provider Details

I. General information

NPI: 1386001345
Provider Name (Legal Business Name): LEAH MARIE THEEMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEAH MARIE PEARL CRNA

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

PO BOX 905
ST JOHNSBURY VT
05819-0905
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax: 603-640-1228
Mailing address:
  • Phone: 802-748-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101.0124948
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number026.0055715
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number059143-21
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116798-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: