Provider Demographics
NPI:1114757903
Name:LETZO, JOHN JOSEPH (CRNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:LETZO
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2529
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:354 CLYMER CORRY RD
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:NY
Practice Address - Zip Code:14724-9701
Practice Address - Country:US
Practice Address - Phone:716-355-2248
Practice Address - Fax:716-355-2254
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily