MEDICARE: LESLIE BARBARA WASHBURN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209631	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP2094	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1053365205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BARBARA WASHBURN NP

Provider Business Mailing Address
First Line	:	33 NORTH ST
Second Line	:
City	:	DALTON
State	:	MA
Zip	:	01226-1202
Country	:	US
Telephone Number	:	413-684-2110
Fax Number	:	413-684-1517

Provider Business Practice Location Address
First Line	:	33 NORTH ST
Second Line	:
City	:	DALTON
State	:	MA
Zip	:	01226-1202
Country	:	US
Telephone Number	:	413-684-2110
Fax Number	:	413-684-1517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/14/2013

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