Individual
MS. LISA LEEDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
512 SKYLINE BLVD, CLOQUET, MN 55720-3787
(218) 879-4641
(218) 879-9167
Mailing address
512 SKYLINE BLVD, CLOQUET, MN 55720-1199
(218) 879-4641
(218) 879-9167
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007983
MI
Other
Enumeration date
09/29/2016
Last updated
11/09/2020
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