Provider Demographics
NPI:1093039935
Name:LEAK, CHRISTINE A (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:LEAK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CEREAL AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2776
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:STE 300
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2776
Practice Address - Country:US
Practice Address - Phone:513-751-2145
Practice Address - Fax:513-751-2138
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11391-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3057598Medicaid
KY7100179630Medicaid
OH3057598Medicaid
KY7100179630Medicaid