Healthcare Provider Details

I. General information

NPI: 1104138601
Provider Name (Legal Business Name): LEIGH ANN PANSCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 FAR HILLS AVE
DAYTON OH
45429-2381
US

IV. Provider business mailing address

10506 MONTGOMERY RD STE. 402
CINCINNATI OH
45242-4487
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-3820
  • Fax: 937-433-9612
Mailing address:
  • Phone: 513-791-6161
  • Fax: 513-791-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11558-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: