Provider Demographics
NPI:1255138467
Name:PAVLISH, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PAVLISH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 152ND PL
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2389
Mailing Address - Country:US
Mailing Address - Phone:952-847-0249
Mailing Address - Fax:
Practice Address - Street 1:2929 CALIFORNIA PLZ # 4371
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1502
Practice Address - Country:US
Practice Address - Phone:952-847-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant