Provider Demographics
NPI:1043677248
Name:MARTIN, LEANN M (CRNP)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTH QUEEN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3550
Mailing Address - Country:US
Mailing Address - Phone:717-779-4353
Mailing Address - Fax:
Practice Address - Street 1:1858 CHARTER LN
Practice Address - Street 2:STE 203
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6743
Practice Address - Country:US
Practice Address - Phone:717-779-4353
Practice Address - Fax:717-274-1659
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015734363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA482407FLTMedicare PIN