Individual
LEAH ELIZABETH GONNEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1642 N MARSHFIELD AVE APT 2R, CHICAGO, IL 60622-1445
(207) 436-5078
Mailing address
1642 N MARSHFIELD AVE APT 2R, CHICAGO, IL 60622-1445
(207) 436-5078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008942
IL
Other
Enumeration date
02/25/2022
Last updated
05/20/2022
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