Provider Demographics
NPI:1043649759
Name:ORTIZ, LEAH MICHELLE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9202
Mailing Address - Country:US
Mailing Address - Phone:717-569-8773
Mailing Address - Fax:717-569-8187
Practice Address - Street 1:640 E OREGON RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9202
Practice Address - Country:US
Practice Address - Phone:717-569-8773
Practice Address - Fax:717-569-8187
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily