Basic Information
| Provider Information | |||||||||
| NPI: | 1700253044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN OSSELAER | ||||||||
| FirstName: | LEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3827 N LAFAYETTE ST | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802053339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035001518 | ||||||||
| FaxNumber: | 2103405924 | ||||||||
| Practice Location | |||||||||
| Address1: | 5282 MEDICAL DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103419614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2015 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.