Provider Demographics
NPI:1063930550
Name:MARTIN, LEAH KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHRYN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHRYN
Other - Last Name:FARINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1277 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-4605
Mailing Address - Country:US
Mailing Address - Phone:231-672-6187
Mailing Address - Fax:
Practice Address - Street 1:1277 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-4605
Practice Address - Country:US
Practice Address - Phone:231-672-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant