NPI: 1972250009
Provider Name: LEATHERMAN HEALTHCARE, LLC
Former Legal Business Name: LEATHERMAN HEALTHCARE, LLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization
Specialization: Primary Care
CLIA Number: 21D2258708
Address:
118 E OAK RIDGE DR STE 2000
HAGERSTOWN, MD
ZIP 21740
Phone: (301) 678-1839
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LEATHERMAN HEALTHCARE, LLC is a primary care nurse practitioner in Hagerstown, MD. LEATHERMAN HEALTHCARE, LLC NPI is 1972250009. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Leatherman Healthcare, Llc.
The provider's business location address is:
118 E OAK RIDGE DR STE 2000
HAGERSTOWN, MD
ZIP 21740-890
Phone: (301) 678-1839
Fax: (301) 679-1740
The provider's authorized official is Gwenn Leatherman .
The authorized official title is Ceo and has the following contact phone number (301) 418-5828.
The CLIA number assigned to this NPI record is 21D2258708 - other - fnp owned pcp with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/8/2022 and was last updated on 11/23/2022.