Provider Demographics
NPI:1871592980
Name:MOSER, LEILA DENISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:DENISE
Last Name:MOSER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LEILA
Other - Middle Name:DENISE
Other - Last Name:BOVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1436
Mailing Address - Country:US
Mailing Address - Phone:330-375-3315
Mailing Address - Fax:
Practice Address - Street 1:55 ARCH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1423
Practice Address - Country:US
Practice Address - Phone:330-375-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.06645363L00000X
OHNP06645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301753Medicaid
OH2301753Medicaid
OHBONP09331Medicare ID - Type Unspecified