Provider Demographics
NPI:1851906416
Name:SPRANG, LEON C
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:C
Last Name:SPRANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W FAIR AVE REAR ALLEY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1803
Mailing Address - Country:US
Mailing Address - Phone:740-503-5667
Mailing Address - Fax:
Practice Address - Street 1:134 W FAIR AVE REAR ALLEY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1803
Practice Address - Country:US
Practice Address - Phone:740-503-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305442Medicaid