Basic Information
| Provider Information | |||||||||
| NPI: | 1699109157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREUEL | ||||||||
| FirstName: | LEANN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7974 UW HEALTH CT | ||||||||
| Address2: | |||||||||
| City: | MIDDLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535625531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088295247 | ||||||||
| FaxNumber: | 6088330999 | ||||||||
| Practice Location | |||||||||
| Address1: | 2977 COUNTY ROAD CX | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539019271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087423004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2013 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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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 | 3180-23 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 3180 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.