Provider Demographics
NPI:1588012538
Name:GILLIVER, LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:GILLIVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E ROWAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1203
Mailing Address - Country:US
Mailing Address - Phone:509-489-3554
Mailing Address - Fax:509-489-3558
Practice Address - Street 1:220 E ROWAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1203
Practice Address - Country:US
Practice Address - Phone:509-489-3554
Practice Address - Fax:509-489-3558
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2087383Medicaid