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General NPI Number Information
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NPI Number | 1518569698
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Entity Type | Individual
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Provider Name | JENNIFER LEACH PA
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Gender | Female
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 1213 E CLAY ST
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City | RICHMOND
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State | VA
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Zip | 23298-5071
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Country | US
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Telephone | 800-762-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 203 HULL ST APT 4A
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City | RICHMOND
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State | VA
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Zip | 23224-4275
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Country | US
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Telephone | 919-946-5253
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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