MEDICARE: MRS. LESLIE KIRSCHNER 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	363LF0000X	Family Nurse Practitioner	16447-NP	OH

General Provider Information

NPI Number	:	1467852467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE KIRSCHNER CNP

Provider Business Mailing Address
First Line	:	10029 BROOKFIELD DR
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6760
Country	:	US
Telephone Number	:	440-476-7989
Fax Number	:	440-354-0752

Provider Business Practice Location Address
First Line	:	20050 HARVARD AVE STE 300
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44122-6800
Country	:	US
Telephone Number	:	216-751-1212
Fax Number	:	216-991-4587

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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