Healthcare Provider Details

I. General information

NPI: 1154831501
Provider Name (Legal Business Name): LESLY CASTRO HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PARK ST
LAWRENCE MA
01841-2517
US

IV. Provider business mailing address

150 PARK ST
LAWRENCE MA
01841-2517
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-1770
  • Fax: 978-682-5787
Mailing address:
  • Phone: 978-685-1770
  • Fax: 978-682-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2267971
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: