=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659776714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH ANN GRATZ CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2014
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5399 LAUBY RD STE 220
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-1590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-615-6498
-----------------------------------------------------
Fax | 978-645-6903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12224 SAN MARINO AVE NW
-----------------------------------------------------
City | UNIONTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44685-5731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-631-5346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | COA 16684-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------