Healthcare Provider Details

I. General information

NPI: 1013990845
Provider Name (Legal Business Name): LORI L LEIPHEIMER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/02/2024
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

IV. Provider business mailing address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax:
Mailing address:
  • Phone: 330-286-0050
  • Fax: 330-759-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.04876
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009089
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP009089
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number04876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: