Healthcare Provider Details

I. General information

NPI: 1750441531
Provider Name (Legal Business Name): LESLIE A PHILLIPS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-5671
  • Fax:
Mailing address:
  • Phone: 202-884-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN56738
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: