Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01068297A | IN |
NPI | 1013052794 |
---|---|
Provider Name | Dr. Brianna Lucinda Leachman Haab |
First Address | Muncie, IN 47303-4988 |
Second Address | Lafayette, IN 47905-8764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000670514 | ANTHEM PROVIDER NUMBER (01) | IN |
200984370 | (05) | IN |