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General NPI Number Information
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NPI Number | 1326034539
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Entity Type | Individual
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Provider Name | CARRIE A LEISTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 4465 DARROW RD STE 100
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City | STOW
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State | OH
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Zip | 44224
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Country | US
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Telephone | 330-688-9918
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Fax | 330-688-6338
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Provider Business Mailing Address
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Address Line | 4465 DARROW RD
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City | STOW
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State | OH
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Zip | 44224-1884
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Country | US
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Telephone | 330-688-9918
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Fax | 330-688-6338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50000944
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License Number State | OH
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