Provider Demographics
NPI:1568716504
Name:WOJTKIEWICZ, LEA MICHELE (PA)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:MICHELE
Last Name:WOJTKIEWICZ
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:5800 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4131
Mailing Address - Country:US
Mailing Address - Phone:216-389-3400
Mailing Address - Fax:
Practice Address - Street 1:5800 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4131
Practice Address - Country:US
Practice Address - Phone:440-396-6874
Practice Address - Fax:440-204-7815
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant