Provider Demographics
NPI:1003138314
Name:STALLWORTH, LEAH REBBECA (APRN)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:REBBECA
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:REBBECA
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:19530 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1486
Mailing Address - Country:US
Mailing Address - Phone:216-243-5589
Mailing Address - Fax:
Practice Address - Street 1:19530 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1486
Practice Address - Country:US
Practice Address - Phone:216-243-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health