Healthcare Provider Details

I. General information

NPI: 1558647610
Provider Name (Legal Business Name): LEAH DANIELLE TRIPLET PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
LONDON OH
43140-1115
US

IV. Provider business mailing address

8 E LONG ST APT #609
COLUMBUS OH
43215-2914
US

V. Phone/Fax

Practice location:
  • Phone: 716-359-0007
  • Fax:
Mailing address:
  • Phone: 716-359-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 9106225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: