| Doctor Name: | RAQUEL V DE LEON |
| NPI Number: | 1659481000 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 4704184661 |
| Business Practice Address: | 400 Medical Park Dr Watervliet, MI - 490989225 |
| Business Phone Number: | 2694633600 |
| Business Fax Number: | |
| Mailing Address: | 400 Medical Park Dr, WATERVLIET |
| State: | MI |
| Postal Code: | 490989225 |
| Phone Number: | 2694633600 |
| Fax Number: | 2694687687 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 11/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704184661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |