Provider Demographics
NPI:1255688552
Name:LEONTIE, WENDY G (PA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:LEONTIE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:65 FREMONT ST OFC 1
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1271
Mailing Address - Country:US
Mailing Address - Phone:508-485-3665
Mailing Address - Fax:508-485-0899
Practice Address - Street 1:65 FREMONT ST OFC 1
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1271
Practice Address - Country:US
Practice Address - Phone:508-485-3665
Practice Address - Fax:508-485-0899
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2019-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant