Healthcare Provider Details

I. General information

NPI: 1669522934
Provider Name (Legal Business Name): LEAH MARTIN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W GARFIELD RD
AURORA OH
44202-8821
US

IV. Provider business mailing address

1050 SOMERSET LN
AURORA OH
44202-7343
US

V. Phone/Fax

Practice location:
  • Phone: 330-562-7032
  • Fax:
Mailing address:
  • Phone: 740-275-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA-08671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: