Provider Demographics
NPI:1083695308
Name:LEONARD, ADRIANE JANET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:JANET
Last Name:LEONARD
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 1:420 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-8340
Mailing Address - Fax:920-926-8370
Practice Address - Street 1:430 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4560
Practice Address - Country:US
Practice Address - Phone:920-929-2300
Practice Address - Fax:920-926-8370
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13835OtherDEAN
WI41997400Medicaid
WI800598OtherTOUCHPOINT
WIP00189988OtherRAILROAD MEDICARE
WI41997400Medicaid
WI019940543Medicare PIN
WI13835OtherDEAN
WI016722245Medicare ID - Type Unspecified