Provider Demographics
NPI:1700213543
Name:BUCHOLZ, LEAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BUCHOLZ
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 1:1 FM 3351 S STE 115-1
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5787
Mailing Address - Country:US
Mailing Address - Phone:830-469-6202
Mailing Address - Fax:
Practice Address - Street 1:756 PURPLE SAGE RD
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3981
Practice Address - Country:US
Practice Address - Phone:830-225-1622
Practice Address - Fax:830-460-5055
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1109697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant