Provider Demographics
NPI:1073663324
Name:WINES, LEANNE NASSAR (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LEANNE
Middle Name:NASSAR
Last Name:WINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:HOSPITALIST OFFICE, BRIGHAM AND WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-699-1808
Mailing Address - Fax:
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:COX 630
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2606
Practice Address - Country:US
Practice Address - Phone:617-724-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2258363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical