Provider Demographics
NPI:1427361740
Name:PIECZYNSKI, LEAH TERESE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:TERESE
Last Name:PIECZYNSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:716 ELM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2556
Mailing Address - Country:US
Mailing Address - Phone:847-501-4040
Mailing Address - Fax:847-501-4075
Practice Address - Street 1:716 ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2556
Practice Address - Country:US
Practice Address - Phone:847-501-4040
Practice Address - Fax:847-501-4075
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085001895363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical