Basic Information
| Provider Information | |||||||||
| NPI: | 1184179673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYLAND | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 ELECTRIC AVE | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430812630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144196820 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5345 HENDRON RD | ||||||||
| Address2: | |||||||||
| City: | GROVEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431251055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148350070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2016 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 350608 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.