Provider Demographics
NPI:1083216477
Name:CASSERLIE, LEANNE MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARGARET
Last Name:CASSERLIE
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 1:30 W MCCREIGHT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1853
Mailing Address - Country:US
Mailing Address - Phone:937-523-9885
Mailing Address - Fax:937-523-9886
Practice Address - Street 1:30 W MCCREIGHT AVE STE 106
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:937-523-9885
Practice Address - Fax:937-523-9886
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006754363AS0400X
OH50.006754RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical