Provider Demographics
NPI:1861176687
Name:LEBO, JULIANNE
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:LEBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7886 GLENGATE DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1764
Mailing Address - Country:US
Mailing Address - Phone:440-554-0804
Mailing Address - Fax:
Practice Address - Street 1:7886 GLENGATE DR
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1764
Practice Address - Country:US
Practice Address - Phone:440-554-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant