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NPI Code Detail

MEDICARE: LEISA BRIDLE MSN, CRNP

MEDICARE: LEISA BRIDLE MSN, 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
1363L00000XNurse PractitionerNP-07291OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2500030347OTHEROHRR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1750383675
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEISA BRIDLE MSN, CRNP
Provider Business Mailing Address
First Line : 525 E MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44304-1698
Country : US
Telephone Number : 330-375-6572
Fax Number : 330-375-6576
Provider Business Practice Location Address
First Line : 411 E MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44304-1542
Country : US
Telephone Number : 330-252-0600
Fax Number : 330-252-0700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 10/18/2024

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Directions to “ LEISA BRIDLE MSN, CRNP” Practice Location

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