MEDICARE: MRS. JENNIFER LEAH ERHARDT CNP

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	363LA2200X	Adult Health Nurse Practitioner	COA.16416	OH

General Provider Information

NPI Number	:	1215335013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEAH ERHARDT CNP

Provider Business Mailing Address
First Line	:	16215 MADISON AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-5618
Country	:	US
Telephone Number	:	216-521-4400
Fax Number	:	216-521-3338

Provider Business Practice Location Address
First Line	:	21245 LORAIN RD
Second Line	:	STE 206
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-2140
Country	:	US
Telephone Number	:	216-283-7200
Fax Number	:	216-295-7014

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

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/19/2017

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