Basic Information
| Provider Information | |||||||||
| NPI: | 1245488303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONGISTO | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | RACHELLE | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 LUDINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064285403 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 LUDINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064285403 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 12/24/2008 | ||||||||
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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 | 363L00000X | 4704191790 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | 4704191790 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.