Provider Demographics
NPI:1538522115
Name:LEIS, SARA MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELLE
Last Name:LEIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:2 KEEFER DR
Practice Address - Street 2:
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-1732
Practice Address - Country:US
Practice Address - Phone:717-328-2119
Practice Address - Fax:717-328-0071
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103160646Medicaid