Provider Demographics
NPI:1164703732
Name:ANDERSON, LEIGH STAEBELL (CNP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:STAEBELL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:STAEBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4602
Mailing Address - Country:US
Mailing Address - Phone:614-788-5400
Mailing Address - Fax:614-788-5500
Practice Address - Street 1:290 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4602
Practice Address - Country:US
Practice Address - Phone:740-788-5400
Practice Address - Fax:614-788-5500
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12646363LF0000X
OHRN.319040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058394Medicaid
OHH046000Medicare PIN