Provider Demographics
NPI:1922734151
Name:STUCK, LEAH MARIE (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:STUCK
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:CHRIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1092 US HIGHWAY 224
Mailing Address - Street 2:
Mailing Address - City:NOVA
Mailing Address - State:OH
Mailing Address - Zip Code:44859-9770
Mailing Address - Country:US
Mailing Address - Phone:330-416-1605
Mailing Address - Fax:
Practice Address - Street 1:229 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3663
Practice Address - Country:US
Practice Address - Phone:541-779-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG06220193363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care