Provider Demographics
NPI:1821568858
Name:HAUBRICH, LEAH M
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:HAUBRICH
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 1:1205 COPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7002
Mailing Address - Country:US
Mailing Address - Phone:152-620-4045
Mailing Address - Fax:515-262-0489
Practice Address - Street 1:1205 COPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7002
Practice Address - Country:US
Practice Address - Phone:515-262-0404
Practice Address - Fax:515-262-0489
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAA131768363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program