MEDICARE: LESLIE MCDONOUGH SHARPE N.P.

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	201228	NC

General Provider Information

NPI Number	:	1447310172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MCDONOUGH SHARPE N.P.

Provider Business Mailing Address
First Line	:	104 MALDON DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-1752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7718 SYLVAN RD
Second Line	:
City	:	SNOW CAMP
State	:	NC
Zip	:	27349-9504
Country	:	US
Telephone Number	:	336-506-0631
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	06/04/2013

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