Healthcare Provider Details

I. General information

NPI: 1891342085
Provider Name (Legal Business Name): JASON EDWARD LEFFEW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

3535 PENTAGON BLVD
BEAVERCREEK OH
45431-1705
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-4331
  • Fax: 937-522-7513
Mailing address:
  • Phone: 937-702-4024
  • Fax: 937-702-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.025093
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.025093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: