Healthcare Provider Details

I. General information

NPI: 1831182724
Provider Name (Legal Business Name): KATHRYN LESIEWICZ ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH CENTER DR
AHOSKIE NC
27910-8161
US

IV. Provider business mailing address

PO BOX 669
AHOSKIE NC
27910-0669
US

V. Phone/Fax

Practice location:
  • Phone: 252-209-0237
  • Fax: 252-209-0197
Mailing address:
  • Phone: 252-209-0237
  • Fax: 252-209-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR50265
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: