Healthcare Provider Details

I. General information

NPI: 1851354013
Provider Name (Legal Business Name): ANN C LEBARON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 W. LOOMIS RD. STE 300
GREENFIELD WI
53221
US

IV. Provider business mailing address

4131 W. LOOMIS RD. STE 300
GREENFIELD WI
53221
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-7246
  • Fax: 414-325-3770
Mailing address:
  • Phone: 414-325-7246
  • Fax: 414-325-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number826-023
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number826
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: