Provider Demographics
NPI:1063414878
Name:BACH, LEANN G (PA-C)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:G
Last Name:BACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414N VERCLER RD 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-924-4681
Mailing Address - Fax:509-922-7634
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2715
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA806048900OtherMEDICAID OTHER
6016BAOtherASURIS NW HEALTH
WA8329666Medicaid
WA8329666Medicaid
WA806048900OtherMEDICAID OTHER
G319213900Medicare PIN