Provider Demographics
NPI:1598306318
Name:HIMMELRICK, LEAH MEGAN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MEGAN
Last Name:HIMMELRICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JOHNSON RD STE 207
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2372
Mailing Address - Country:US
Mailing Address - Phone:740-266-9169
Mailing Address - Fax:740-266-6933
Practice Address - Street 1:4100 JOHNSON RD STE 207
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2372
Practice Address - Country:US
Practice Address - Phone:740-266-9169
Practice Address - Fax:740-266-6933
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104726363LF0000X
WV92886163W00000X
OHAPRN.CNP.025842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019057542OtherANCC CERTIFICATION NUMBER FNP-BC