Provider Demographics
NPI:1538199641
Name:TONWEBER, LEANDRA M (PA-C)
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:M
Last Name:TONWEBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEANDRA
Other - Middle Name:
Other - Last Name:TONWEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8810 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6595
Mailing Address - Country:US
Mailing Address - Phone:704-910-1402
Mailing Address - Fax:
Practice Address - Street 1:8810 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6595
Practice Address - Country:US
Practice Address - Phone:704-910-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103600207K00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102021Medicaid
SC0460PAMedicaid
NC2320359Medicare UPIN
NC2325437Medicare PIN
NC2347639Medicare UPIN
P91676Medicare UPIN
NC2331634AMedicare UPIN
NC2331634MMedicare UPIN
NC2331634TMedicare UPIN
NC2334282RMedicare UPIN
NC2344402Medicare UPIN
NC2344613Medicare UPIN
SC0460PAMedicaid
SCP916765215Medicare PIN
NC2308652Medicare UPIN
NC2331634UMedicare UPIN
2347639AMedicare UPIN
NC2331634BMedicare UPIN
NC2331634QMedicare UPIN
NC2334282DMedicare UPIN
NC2335645AMedicare UPIN