Healthcare Provider Details

I. General information

NPI: 1568013753
Provider Name (Legal Business Name): LESLIE MARIE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 RIVER RD
NORTH ANSON ME
04958-7134
US

IV. Provider business mailing address

PO BOX 203
WINTHROP ME
04364-0203
US

V. Phone/Fax

Practice location:
  • Phone: 207-491-7756
  • Fax:
Mailing address:
  • Phone: 207-446-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: