Provider Demographics
NPI:1972333482
Name:JEGLUM, LEAH MICHELE (NP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELE
Last Name:JEGLUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JEGLUM
Other - Last Name:TINDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1675 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0002
Mailing Address - Country:US
Mailing Address - Phone:608-263-7337
Mailing Address - Fax:
Practice Address - Street 1:1675 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0002
Practice Address - Country:US
Practice Address - Phone:608-263-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15691-33363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care