Basic Information
| Provider Information | |||||||||
| NPI: | 1003147851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEU-HENTHORN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4805 E HIGHWAY 37 | ||||||||
| Address2: | |||||||||
| City: | TUTTLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730898791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053819979 | ||||||||
| FaxNumber: | 4056892106 | ||||||||
| Practice Location | |||||||||
| Address1: | 4805 E HIGHWAY 37 | ||||||||
| Address2: | |||||||||
| City: | TUTTLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730898791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053819979 | ||||||||
| FaxNumber: | 4056892106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 979 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.