Healthcare Provider Details

I. General information

NPI: 1477913671
Provider Name (Legal Business Name): LINN LECLAIR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # C21
CLEVELAND OH
44195-3422
US

IV. Provider business mailing address

9500 EUCLID AVE # C21
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0517
  • Fax: 216-445-7000
Mailing address:
  • Phone: 216-445-0517
  • Fax: 216-445-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004625RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004625RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: