Provider Demographics
NPI:1215335013
Name:ERHARDT, JENNIFER LEAH (CNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEAH
Last Name:ERHARDT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEAH
Other - Last Name:DIETERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16215 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5618
Mailing Address - Country:US
Mailing Address - Phone:216-521-4400
Mailing Address - Fax:216-521-3338
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:STE 206
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2140
Practice Address - Country:US
Practice Address - Phone:216-283-7200
Practice Address - Fax:216-295-7014
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16416363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health