Provider Demographics
NPI:1528592086
Name:POE, LEANDRA
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 193RD ST
Mailing Address - Street 2:403
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1373
Mailing Address - Country:US
Mailing Address - Phone:216-777-0452
Mailing Address - Fax:
Practice Address - Street 1:1500 E 193RD ST
Practice Address - Street 2:403
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1373
Practice Address - Country:US
Practice Address - Phone:216-777-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092096Medicaid