Individual
LEAH BUSTARD EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-3663
(215) 707-6417
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-3663
(215) 707-6417
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA051368
PA
Other
Enumeration date
04/29/2008
Last updated
03/17/2018
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