Provider Demographics
NPI:1598166571
Name:O'BRYAN, LEIGH ALLISON (CRNA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ALLISON
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ALLISON
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4200 WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113
Mailing Address - Country:US
Mailing Address - Phone:304-532-7022
Mailing Address - Fax:
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-6000
Practice Address - Fax:330-344-1714
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.006433367500000X
OHCOA.16488367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110754Medicaid
OH103671OtherAANA
OH000000894496OtherANTHEM
OHP01437071OtherRR MEDICARE
OHP01437071OtherRR MEDICARE