Provider Demographics
NPI:1942314992
Name:LEECE, LAURIE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:LEECE
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 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-242-4300
Mailing Address - Fax:541-242-4305
Practice Address - Street 1:1007 HARLOW RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7124
Practice Address - Country:US
Practice Address - Phone:541-242-4300
Practice Address - Fax:541-242-4305
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00333363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500616916Medicaid
OR500616916Medicaid