Provider Demographics
NPI:1083128433
Name:FABIS, LEAH (APNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:FABIS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:MADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:ONE PERSNICKETY WAY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073
Mailing Address - Country:US
Mailing Address - Phone:888-893-6141
Mailing Address - Fax:608-338-0971
Practice Address - Street 1:ONE PERSNICKETY WAY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073
Practice Address - Country:US
Practice Address - Phone:888-893-6141
Practice Address - Fax:608-338-0971
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7729-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily