Individual
DR. LEIGH MAE PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 735-7645
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 735-7645
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
83019
WI
390200000X
Student in an Organized Health Care Education/Training Program
RS2020-0448
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2017
Last updated
05/15/2024
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