Provider Demographics
NPI:1225376940
Name:VOGEL, LEAH ANN (PA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ANN
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ANN
Other - Last Name:FRIEDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:816 22ND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2206
Mailing Address - Country:US
Mailing Address - Phone:308-865-2263
Mailing Address - Fax:308-865-2541
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:308-865-2541
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1705OtherSTATE LICENSE