Provider Demographics
NPI:1447483987
Name:VANSICKLER, LEIGHANNE K (PA-C)
Entity type:Individual
Prefix:MS
First Name:LEIGHANNE
Middle Name:K
Last Name:VANSICKLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGHANNE
Other - Middle Name:K
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1291
Mailing Address - Country:US
Mailing Address - Phone:989-723-8666
Mailing Address - Fax:989-725-1434
Practice Address - Street 1:200 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1291
Practice Address - Country:US
Practice Address - Phone:989-723-8666
Practice Address - Fax:989-725-1434
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant