Healthcare Provider Details

I. General information

NPI: 1750383675
Provider Name (Legal Business Name): LEISA BRIDLE MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E MARKET ST
AKRON OH
44304-1542
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1698
US

V. Phone/Fax

Practice location:
  • Phone: 330-252-0600
  • Fax: 330-252-0700
Mailing address:
  • Phone: 330-375-6572
  • Fax: 330-375-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-07291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: