Healthcare Provider Details

I. General information

NPI: 1215335013
Provider Name (Legal Business Name): JENNIFER LEAH ERHARDT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JENNIFER LEAH DIETERICH

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21245 LORAIN RD STE 206
FAIRVIEW PARK OH
44126-2140
US

IV. Provider business mailing address

16215 MADISON AVE
LAKEWOOD OH
44107-5618
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-7200
  • Fax: 216-295-7014
Mailing address:
  • Phone: 216-521-4400
  • Fax: 216-521-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.16416
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: