Provider Demographics
NPI:1336910249
Name:HALBLAUB, LEA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:HALBLAUB
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 1:323 SPRINGBROOK DR APT 110
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3604
Mailing Address - Country:US
Mailing Address - Phone:330-571-9764
Mailing Address - Fax:
Practice Address - Street 1:277 TOWNSHIP ROAD 350
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9701
Practice Address - Country:US
Practice Address - Phone:419-921-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402107850918376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide