MEDICARE: LEAH T NYE FNP-BC

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	06844NP	OH
2	363LF0000X	Family Nurse Practitioner	98044	WV
3	363L00000X	Nurse Practitioner	NP06844	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	:	1912005620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH T NYE FNP-BC

Provider Business Mailing Address
First Line	:	6780 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2203
Country	:	US
Telephone Number	:	440-312-6544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6780 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2203
Country	:	US
Telephone Number	:	440-312-6544
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/29/2021

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