Healthcare Provider Details

I. General information

NPI: 1114757903
Provider Name (Legal Business Name): JOHN JOSEPH LETZO CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 CLYMER CORRY RD
CLYMER NY
14724-9701
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 716-355-2248
  • Fax: 716-355-2254
Mailing address:
  • Phone: 814-868-2529
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: