Healthcare Provider Details

I. General information

NPI: 1972202224
Provider Name (Legal Business Name): ERICA MARIE LEDDY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

1020 EDWARDS DR
SPRINGFIELD PA
19064-3712
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-0100
  • Fax:
Mailing address:
  • Phone: 717-917-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP027147
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP027147
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: