Healthcare Provider Details

I. General information

NPI: 1285921353
Provider Name (Legal Business Name): LEIGH A MCGOUGH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH A JASHINSKY APNP

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST STE A
MADISON WI
53715-1830
US

IV. Provider business mailing address

700 S PARK ST
MADISON WI
53715-1830
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax: 608-260-3447
Mailing address:
  • Phone: 608-260-2900
  • Fax: 608-260-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4434
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704284052
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4434-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: