MEDICARE: LORI L LEIPHEIMER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.04876	OH
2	363LF0000X	Family Nurse Practitioner	SP009089	PA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP009089	PA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	04876	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024283	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013990845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI L LEIPHEIMER CRNP

Provider Business Mailing Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:	330-759-3851

Provider Business Practice Location Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	01/02/2024

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Directions to “ LORI L LEIPHEIMER CRNP” Practice Location

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