Provider Demographics
NPI:1619363827
Name:FEATHER, LEANNE
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:
Last Name:FEATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 QUENTIN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6929
Mailing Address - Country:US
Mailing Address - Phone:717-450-5940
Mailing Address - Fax:717-450-5586
Practice Address - Street 1:989 QUENTIN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6929
Practice Address - Country:US
Practice Address - Phone:717-450-5940
Practice Address - Fax:717-450-5586
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25523601172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA464424595Other25523601 PA LICENSE