Individual
JESSE ISOBEL LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3021 VOYAGER DR, GREEN BAY, WI 54311-8303
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46535
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34018200
—
WI
Enumeration date
07/09/2006
Last updated
07/08/2007
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