Provider Demographics
NPI:1063670784
Name:MORSE, LEAH K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:K
Last Name:MORSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:K
Other - Last Name:HARTENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 WASHINGTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8972
Mailing Address - Country:US
Mailing Address - Phone:802-888-8405
Mailing Address - Fax:802-888-8206
Practice Address - Street 1:555 WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8972
Practice Address - Country:US
Practice Address - Phone:802-888-8405
Practice Address - Fax:802-888-8406
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VT055-0031036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000472Medicaid
VT9000472Medicaid