Provider Demographics
NPI:1760189286
Name:POWELL, LESHA MARIE
Entity Type:Individual
Prefix:
First Name:LESHA
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14595 STANWOOD ST SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-8704
Mailing Address - Country:US
Mailing Address - Phone:330-705-7545
Mailing Address - Fax:
Practice Address - Street 1:14595 STANWOOD ST SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-8704
Practice Address - Country:US
Practice Address - Phone:330-705-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.291172163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator