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General NPI Number Information
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NPI Number | 1336868348
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Entity Type | Individual
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Provider Name | LEAH JACQUELINE HERMAN MPH, PA-S
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 413 29TH ST NE STE I
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City | PUYALLUP
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State | WA
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Zip | 98372-7154
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Country | US
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Telephone | 855-255-1750
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Fax | 855-255-0905
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Provider Business Mailing Address
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Address Line | 4555 39TH AVE SW APT 413
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City | SEATTLE
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State | WA
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Zip | 98116-4284
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Country | US
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Telephone | 509-859-4098
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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 | PA61496693
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA61496693
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61496693
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License Number State | WA
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