1215335013 NPI number — MRS. JENNIFER LEAH ERHARDT CNP

Table of content: MRS. JENNIFER LEAH ERHARDT CNP (NPI 1215335013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215335013 NPI number — MRS. JENNIFER LEAH ERHARDT CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERHARDT
Provider First Name:
JENNIFER
Provider Middle Name:
LEAH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIETERICH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LEAH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215335013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16215 MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-5618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-521-4400
Provider Business Mailing Address Fax Number:
216-521-3338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21245 LORAIN RD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
FAIRVIEW PARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44126-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-283-7200
Provider Business Practice Location Address Fax Number:
216-295-7014
Provider Enumeration Date:
12/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  COA.16416 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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