Provider Demographics
NPI:1629155163
Name:LEPPINK, LAURA E (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:LEPPINK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:GAVRIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6201 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-9726
Mailing Address - Country:US
Mailing Address - Phone:517-881-5310
Mailing Address - Fax:
Practice Address - Street 1:300 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1014
Practice Address - Country:US
Practice Address - Phone:989-463-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008771120OtherBLUE CROSS BLUE SHIELD
MIP00665152OtherRAILROAD MEDICARE
MI1059826OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1059826OtherMCLAREN HEALTH PLAN-MEDICAID
MI0N55170016OtherMEDICARE PLUS BLUE
MI1059826OtherMCLAREN HEALTH ADVANTAGE
MI200000018089OtherPHP FAMILYCARE
MI200000018089OtherPHP
MI7399969OtherAETNA
MI200000018089OtherPHP FAMILYCARE
MI7399969OtherAETNA