Provider Demographics
NPI:1710433529
Name:TEICHMILLER, LEAH (PA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:TEICHMILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4653
Mailing Address - Country:US
Mailing Address - Phone:217-868-2812
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DR STE 107
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4644
Practice Address - Country:US
Practice Address - Phone:217-258-4096
Practice Address - Fax:217-238-5485
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant