Provider Demographics
NPI:1417187857
Name:LEACH, NICOLE E (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:LEACH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:1607 STATE RD
Practice Address - Street 2:6
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-9142
Practice Address - Country:US
Practice Address - Phone:440-967-8713
Practice Address - Fax:440-967-1938
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10679363LF0000X
OH10679363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OH3025372Medicaid
OHNP32091Medicare PIN
OH9284951Medicare PIN
OH0236248Medicaid