Provider Demographics
NPI:1619495116
Name:LEONARD, DANI NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:NICOLE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2579
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-2579
Mailing Address - Country:US
Mailing Address - Phone:989-205-4500
Mailing Address - Fax:989-794-5942
Practice Address - Street 1:4851 E PICKARD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2029
Practice Address - Country:US
Practice Address - Phone:989-775-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant