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General NPI Number Information
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NPI Number | 1073084703
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Entity Type | Individual
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Provider Name | LEAH ANN HARE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 3716 WILMINGTON PIKE
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City | DAYTON
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State | OH
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Zip | 45429-4845
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Country | US
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Telephone | 937-298-1439
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Fax |
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Provider Business Mailing Address
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Address Line | 121 SHAWNEE RUN APT F
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City | WEST CARROLLTON
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State | OH
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Zip | 45449-3963
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Country | US
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Telephone | 419-787-8658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.005745RX
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License Number State | OH
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