Provider Demographics
NPI:1003384207
Name:STRODTBECK, LESLIE A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:STRODTBECK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 N LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1131
Mailing Address - Country:US
Mailing Address - Phone:440-988-1009
Mailing Address - Fax:
Practice Address - Street 1:840 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-8948
Practice Address - Country:US
Practice Address - Phone:440-647-2225
Practice Address - Fax:440-647-5110
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0326578Medicaid