Provider Demographics
NPI:1376562538
Name:DUNCAN, LESLEE LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LESLEE
Middle Name:LYNN
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LESLEE
Other - Middle Name:LYNN
Other - Last Name:ABSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3905 W ERNESTINE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5800
Mailing Address - Country:US
Mailing Address - Phone:618-993-5859
Mailing Address - Fax:618-997-1588
Practice Address - Street 1:3905 W ERNESTINE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5800
Practice Address - Country:US
Practice Address - Phone:618-993-5859
Practice Address - Fax:618-997-1588
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002485Medicaid
ILQ56365Medicare UPIN
K22644Medicare PIN