Provider Demographics
NPI:1669522934
Name:MARTIN, LEAH (CFNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-7343
Mailing Address - Country:US
Mailing Address - Phone:740-275-7687
Mailing Address - Fax:
Practice Address - Street 1:118 W GARFIELD RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8821
Practice Address - Country:US
Practice Address - Phone:330-562-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-08671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008185Medicaid
WV3810008185Medicaid
OHMANP22972Medicare PIN
110102PK7Medicare PIN