Provider Demographics
NPI:1700253044
Name:VAN OSSELAER, LEIGH
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:VAN OSSELAER
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 1:3827 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3339
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:210-340-5924
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4849
Practice Address - Country:US
Practice Address - Phone:210-341-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant