Provider Demographics
NPI:1679558183
Name:LEITE, THERESA H (CNM)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:H
Last Name:LEITE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E ELM ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2850
Mailing Address - Country:US
Mailing Address - Phone:419-224-2632
Mailing Address - Fax:419-222-2731
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2850
Practice Address - Country:US
Practice Address - Phone:419-224-2632
Practice Address - Fax:419-222-2731
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM04988176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492128Medicaid
OH2492128Medicaid
OHLENM01066Medicare UPIN