Healthcare Provider Details

I. General information

NPI: 1972492486
Provider Name (Legal Business Name): HUNTER NATHAN LEATHERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W CLYBOURN ST,
MILWAUKEE WI
53233
US

IV. Provider business mailing address

1250 W WISCONSIN AVE
MILWAUKEE WI
53233-2225
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-5688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: