Healthcare Provider Details

I. General information

NPI: 1043677248
Provider Name (Legal Business Name): LEANN M MARTIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 CHARTER LN STE 203
LANCASTER PA
17601-6743
US

IV. Provider business mailing address

100 NORTH QUEEN STREET SUITE 200
LANCASTER PA
17603-3550
US

V. Phone/Fax

Practice location:
  • Phone: 717-779-4353
  • Fax: 717-274-1659
Mailing address:
  • Phone: 717-779-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP015734
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015734
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: