Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN.399571 | OH |
NPI | 1134722499 |
---|---|
Provider Name | Matthew James Leidel |
First Address | Hartville, OH 44632-9115 |
Second Address | Canton, OH 44708-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2020 |
Last Update Date | 19/11/2020 |