MEDICARE: LEATHA M ROSS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.06909	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487720801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEATHA M ROSS CRNP

Provider Business Mailing Address
First Line	:	30 W MCCREIGHT AVE STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1853
Country	:	US
Telephone Number	:	937-523-9050
Fax Number	:	937-523-9059

Provider Business Practice Location Address
First Line	:	30 W MCCREIGHT AVE STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1853
Country	:	US
Telephone Number	:	937-523-9050
Fax Number	:	937-523-9059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/10/2024

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