Provider Demographics
NPI:1952841801
Name:NIDA, LEAH ASHLEY (MSN, NP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ASHLEY
Last Name:NIDA
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ASHLEY
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8743 SHELBY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2552
Mailing Address - Country:US
Mailing Address - Phone:248-342-9314
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner