Provider Demographics
NPI:1407086036
Name:EHLE, LEAH KAY (APRN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KAY
Last Name:EHLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KAY
Other - Last Name:BYMATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5529
Mailing Address - Country:US
Mailing Address - Phone:186-024-6257
Mailing Address - Fax:
Practice Address - Street 1:360 TOLLAND TPKE STE 2C
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1770
Practice Address - Country:US
Practice Address - Phone:186-064-3800
Practice Address - Fax:186-024-6369
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004114363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health