Individual
TRISHA LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.005984
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
424816172
BLUE CROSS BLUE SHIELD PROVIDER IDENTIFICATION
—
01
—
5495981
AETNA PROVIDER IDENTIFICATION
—
Enumeration date
10/05/2016
Last updated
03/19/2019
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