Provider Demographics
NPI:1003545583
Name:LEECH, JENNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:LEECH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10145 MARTIS VALLEY RD APT 3
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2196
Mailing Address - Country:US
Mailing Address - Phone:925-337-1846
Mailing Address - Fax:
Practice Address - Street 1:10051 LAKE AVE STE 3
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4870
Practice Address - Country:US
Practice Address - Phone:530-587-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61158207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty