Provider Demographics
NPI:1538646492
Name:LELIGDON, LAUREL (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:
Last Name:LELIGDON
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-566-9601
Mailing Address - Fax:614-566-8631
Practice Address - Street 1:285 E STATE ST STE 460
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4358
Practice Address - Country:US
Practice Address - Phone:614-566-9601
Practice Address - Fax:614-566-8631
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP023189363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316459Medicaid