Healthcare Provider Details

I. General information

NPI: 1508726340
Provider Name (Legal Business Name): LESLIE A. SMITLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL
BROOKLINE MA
02445-7224
US

IV. Provider business mailing address

80 PRESTON ST UNIT 1
WAKEFIELD MA
01880-2538
US

V. Phone/Fax

Practice location:
  • Phone: 617-919-1034
  • Fax:
Mailing address:
  • Phone: 470-334-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10005923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: