Provider Demographics
NPI:1578073185
Name:LEADBETTER, MEGAN MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:LEADBETTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 PRINCEHORN AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9703
Mailing Address - Country:US
Mailing Address - Phone:330-936-0953
Mailing Address - Fax:
Practice Address - Street 1:4883 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3635
Practice Address - Country:US
Practice Address - Phone:330-479-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00020904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily