Healthcare Provider Details

I. General information

NPI: 1861808180
Provider Name (Legal Business Name): LESLIE MARIE LOGAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LESLIE MARIE MCANDREW

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR NURSING BUSINESS OFFICE, HAMMAN BLDG
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR NURSING BUSINESS OFFICE, HAMMAN BLDG
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-3356
  • Fax:
Mailing address:
  • Phone: 216-778-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN.219425-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM16157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: