Provider Demographics
NPI:1417322397
Name:LEYENDECKER, MARY RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RUTH
Last Name:LEYENDECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:RUTH
Other - Last Name:FORBIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP, FNP
Mailing Address - Street 1:1910 FAIRGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1930
Mailing Address - Country:US
Mailing Address - Phone:513-868-0055
Mailing Address - Fax:
Practice Address - Street 1:1910 FAIRGROVE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-1930
Practice Address - Country:US
Practice Address - Phone:513-868-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18443-NP363LF0000X
OHAPRN.18443.CNP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily