MEDICARE: LEANDRA M TONWEBER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	103600	NC
2	363AM0700X	Medical Physician Assistant	103600	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538199641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDRA M TONWEBER PA-C

Provider Business Mailing Address
First Line	:	8810 BLAKENEY PROFESSIONAL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6595
Country	:	US
Telephone Number	:	704-910-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	8810 BLAKENEY PROFESSIONAL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6595
Country	:	US
Telephone Number	:	704-910-1402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/10/2014

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