Healthcare Provider Details

I. General information

NPI: 1093241044
Provider Name (Legal Business Name): REBECCA LEACH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/02/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHAMBER DR
MILFORD OH
45150-1734
US

IV. Provider business mailing address

2830 VICTORY PARKWAY PAYOR ENROLLMENT
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8050
  • Fax: 513-248-1809
Mailing address:
  • Phone: 513-585-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010993
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: