DR. LEIGH MAE PROVENCHER M.D. NPI 1063949741

NPI Information

NPI: 1063949741
Provider Name: DR. LEIGH MAE PROVENCHER, M.D.
Classification: Internal Medicine - 207RC0200X
Specialization: Critical Care Medicine
Entity Type: Individual
PECOS Registration: Yes
Address: 1818 N MEADE ST
APPLETON, WI
ZIP 54911
Phone: (920) 735-7645

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NPI Details

DR. Leigh Mae Provencher, M.D. is a critical care medicine internal medicine in Appleton, WI with 9 years of experience. The provider is an internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. DR. Leigh Mae Provencher, M.D. NPI is 1063949741. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1818 N MEADE ST
APPLETON, WI
ZIP 54911-454
Phone: (920) 735-7645

The NPI 1063949741 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/12/2017 and was last updated on 5/15/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program		RS2020-0448	NEW MEXICO	No
2	390200000X	Student in an Organized Health Care Education/Training Program				No
3	207RC0200X	Internal Medicine	Critical Care Medicine	83019	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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