Individual
MRS. VIRGINIA MARIE BRUDER LEEPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 125, HAGERSTOWN, MD 21742-6799
(301) 714-4335
Mailing address
3024 E EMPIRE ST STE EANDF, BLOOMINGTON, IL 61704-5402
(309) 451-3376
(309) 452-3376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
C00006851
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.008214
PHYSICIAN ASSISTANT
IL
Enumeration date
07/24/2018
Last updated
11/09/2021
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